
5^L 

Book - - V 



ro 



;OpATigilXi\.' 



COPYRIGHT DEPOSIT 



/ 







ANTICIPATION. 



Bougereau. 



TOCOLOGY FOR MOTHERS: 
n medical Guide 

TO THE CARE OF THEIR HEALTH AND THE 
MANAGEMENT OF CHILDREN. 



BT 



ALBERT WESTLAND. 



M.A., M.D., aX. 



U J * ■"' ". 11" -i i -, 



AMERICAN REPRINT EDITION 
PREPARED FOR PUBLICATION WITH ILLUSTRATIONS, 



BT 



E. B. FOOTE, Jr., M. 0. 



NEW YORK : 

MURRAY HIIX PUBLISHING COMPANY, 

129 EAST 28TH STREET. 

1901. 



96424 



(Library of Conaresa| 

iWo Copies Received i 
DEC 2$ 190° 

^ CopyngM <«try 

SECOND COPY 
DeUvercd to 

ORDER DIVISION 

JAN 5 1901 



• • • • « • 
• • • • •• 



OOFYBISHT, 1900, B\ iE. B. FOOTS, M.D. 



0. H. La Babbe. Pbinteb, 106 East 28th Street., New Yobk. 



PUBLISHER'S PREFACE. 



FOR THE AMERICAN EDITION. 

The subjects treated in the following pages are essential to a complete family 
medical cyclopedia, and as Dr. Footers writings have not covered this ground we 
have heretofore offered our customers the well known and deservedly popular books 
by Dr. Chavasse, for wives and mothers, but the plates of our last editions show 
rather too much wear, and the work needed revision as well as resetting. In get- 
ting up a new book we have, for several reasons, preferred to adopt Dr. Westland's 
and adapt it to the ximerican reader. It is less discursive than that of Chavasse, 
or, as we say, "more to the point. 1, It was very 'recently written, is well-balanced, 
"well put," 1 and up-to-date. As the author says in his preface, " the information 
is the common property of every well-educated physician ; " but its presentation 
in a clear, readable, and suitable shape for the ordinary reader is not a task that 
all physicians could do equally well. Dr. Westland's work is not "flowery 11 or 
sentimental, but it is thoroughly practical, and well within the easy comprehension 
of any reader of good English. To those having immediate personal interest in 
matters relating to maternity, it must be of great service both for occasional refer- 
ence and as a book for study. 

Tocology means a discourse on parturition or child-bearing, and on this subject 
there are three classes of books needed. Physicians in that line of practice should 
of course know it all, and their technical text-books embrace a great amount of 
material which is necessary only for them. Books on nursing of women during 
confinement are prepared so as to instruct nurses in their special work and duties. 

Lastly, there is a good deal of knowledge that should be possessed by every 
woman who is about to become a mother, because it will save her much discom- 
fort during gestation, much suffering in labor, and help to prevent accidents and 
complications which should always be avoided when possible. Dr. Westland has 
well selected and presented his advice with the sole purpose of making it an 
acceptable and useful Tocology for Mothers, and besides instructing them in 
the ways and means toward safe and painless childbirth, he has added such instruc- 
tion for motherhood and the care of infants and children as should enable happy 
mothers to successfully raise the tender products of their love and labor. 

We therefore commend this work to every mother, and every woman who 
expects to become a mother. Of course millions of babies have been born to and 
successfully raised by mothers, who have little more than love, instinct, and home 
customs to guide them, but knowledge is, after all, the best reliance, and a large 
part of the present excessive mortality of infants and the accompanying floods of 
mother's tears might be avoided if every prospective mother would read, digest, 
and become familiar with the instructions offered them in this book. 

Where the reviewing editor of this American edition has thought best to 
materially modify the original text or interpolate new matter, it is included in 
brackets, [ ] in order that the author may be protected from misrepresentation 
or being made to say what he did not. 

E. B. FOOTE, Jr. 



AUTHOR'S PREFACE. 



This -work is addressed to -women who are desirous of fulfilling properly their 
duties as wives and mothers, and is designed to assist them in exercising an intel- 
ligent Bnperrision over their ovm and their children's health. The information 

i-cntaized ir: :: i: :"_e : : . : _ rr: perry :: ~-trj ~i~l-ri~cz:e± rips:.:^:. . any 

difficulty -which has presented itself in its composition has arisen in the selection 
of the contents, and their mode of treatmenT. In these reEpetta the author has 
: - en gui . - e xj erience in general medical practice, his object having been 

to convey as much information as an intelligent woman might be expected to 
appreciate and utilize. 

In the char:e: :>n '. rmmon Maladies of Children, systematic description of 
diseases has been avoided, the intention of the author being rather tc give such 
: al information of their character and course as would _ heir recog- 

nition, and afford some guide to their management. 

ALBEBT WESTLAXD. 

30X. 



LIST OF CONTENTS. 



PART I. 



EARLY HARRIED LIFE. 



CHAPTER I. 

PAGE 

Duties and Responsibilities of Married Life H 

.Ignorance before Marriage of Probable Duties and Responsibilities; Impor 
tance of Step taken in entering Matrimony; Necessity of Mutual Self-Sacri- 
fice; Probability of Maternity; Period of Life during which Maternity may 
Occur; Possibility of some Suffering during this Period ; Effect of Mother's 
Life and Conduct on Future Health of Child ; Inherited Tendencies ; Les- 
sons from Examples ; Imitative Faculties of Children. 

CHAPTER II. 

Altered Conditions of r.iFE after Marriage . . IB 

Change in the Circumstances of the Wife; Loss of Family Ties; Formation of 
New Friendships; Utilization of Leisure Hours; Importance of Out-door 
Exercise; Various Forms of Exercise; Value of Motive in Walking; Care 
in Diet; Duty of Taking Proper Care of Health; Place of Alcoholic Stimu- 
lants in Diet; Injurious Effects of Improper Use of Stimulants on Mother 
and Child; Mental Occupation; Tendency to Occasional Depression; 
Methods of Relief; Domestic Troubles; Rule for Avoiding Worry. 

CHAPTER III. 

Signs and Symptoms of Pregnancy 19 

Their Existence and Import; Plan of Consideration; Cessation of Menstrua- 
tion; Its Significance and Value in Determining Probable Duration of Preg- 
nancy; Normal Duration of Pregnancy; Extreme Limits of Duration; 
Methods of Determining Probable Date of Confinement; Examples. Gas- 
tric Derangements; Morning Sickness; Abnormal Sense of Hunger; Crav- 
ing for Unusual Articles of Diet; Pain in Stomach; Other Disorders of Di- 
gestion. Enlargement of Breasts; Tenderness; Prominence of Veins; 
Secretion of Milk; Enlargement and Pigmentation of Areola; Secondary 
Areola ; Quickening and Sensations of Movement of Child ; Possibility of 
Mistake in Sensations; External Evidence of Movement; Increase in Size 
of Abdomen; Period at which Noticeable; Conclusion. 



6 LIST OF CONTENTS. 

CHAPTER IV. 

PAGE 

Management of Unpleasant Disorders or Pregnancy 29 

Nausea and Sickness; Alleviation by Tea; Breakfast in Bed: Effervescing 
Drinks; Care in Diet; Heartburn; Temporary Means of Belief; Water 
Brash; Dietary for Disorders of Digestion in Pregnanes" Constipation; 
Alleviation by Diet; Regular Habits; Drugs; Warm Water; Mineral 
Waters; Salts; Sulphur; Licorice Powder; Senna; Enemas; Method of 
Administration; Injection of Glycerine; Special Syringe desirable; Selec- 
tion of Remedy; Faintness; Remedies; Caution respecting Stimulants; In- 
crease in Size and Sense of Weight; Arrangement of Clothing; Use of Cor- 
sets; Supporting Belts; Stretching of Skm of Abdomen and Breasts; Cause; 
Results; Pigmentation; Prevention; Alleviation; Swelling of Feet and 
Legs; Alleviation; Distention of Veins of Legs; Two Forms; Description; 
Hereditary Tendency; Treatment; Piles, Internal and External; Treat- 
ment; Vaginal Discharge and Irritation; Alleviation; Use of Injections; 
Precautions; Bathing; Sleeplessness; Causes; Remedies; Caution against 
Use of Narcotics. 

CHAPTER V, 

Miscarriage, its Causes, Risks, Prevention, and Management 44 

Definition of Miscarriage ; Usual Periods of Occurrence; Earlier Miscarriages: 
Difficulty of Recognition; Necessity of Care after their Occurrence; Cause 
of Miscarriage; Indications of Threatened Miscarriage; Discharge of 
Blood; Pain; Preventive Treatment; Rest; Coolness; Light Diet; Indica- 
tions for Medical Aid; Necessity of Patience; Symptoms of Inevitable Mis- 
carriage; Description of Abortion; Indications of Complete Removal; Re- 
sults of Incomplete Removal; Convalescence from Miscarriage; Necessity 
of Rest; Value of Ss'ringing; Preparation of Lotions: Diet during Conva- 
lescence; Occasional Discomfort of Breasts: Final Remarks. 



CHAPTER VI. 

Premature Confinement 50 

Definition; Causes; Recognition of Cause ; Cause of Premature Confinement; 
Importance of Prevention; Effects of Premature Birth on Child and on 
Mother; Necessity of Care in Later Months of Pregnancy; Signs of Im- 
pending Confinement; Recurring Attacks of Pain; Distinction from Colic; 
Precautions Necessary; Baby Incubators. 



CHAPTER VII, 

Preparations for Confinement 61 

Selection of Doctor and Nurse: Arrangements Regarding Fees; Advantages 
of Personal Interview with Monthly Nurse; Selection of Room; Drainage 
of House; Accommodation of Nurse ; Furniture of Room ; Bed-Pan; Bed- 
Bath; The Family Syringe; Douche; Sponges: Sanitary Towels; Binders; 
Antiseptic Fluids; Carbolized Vaseline; Baby's Bath: Soap; Baby's Dia- 
pers; Bassinette; Baby's Basket; Its Contents; Waterproof Sheeting; 
Arrangement of Bed ; Attention to Regular Action of Bowels. 



LIST OF CONTENTS. 



CHAPTER VIII. 

PAGE 

Confinement 70 

Definition; Indications of Commencement; Painful Contractions of Womb; 
Frequency; Distinction from "False Pains 11 ; the Show; Demeanor dur- 
ing First Stage ; Propriety of Laxative Medicine; Food; Transition from 
" First Stage " to " Second Stage " ; Description of Contents of Womb, and 
of Action during Labor; Bursting of the Waters; Second Stage; Differing 
Character of Pains; Position of Mother; Termination of Second Stage; 
Position of Child; Management in Absence of Skilled Assistance; Third 
Stage; General Remarks. 



PART II. 



EARLY flOTHERHOOD. 



CHAPTER IX, 

Convalescence from Confinement 78 

Normal Progress after Confinement; Necessity of Quietude; Injurious Effects 
of Excitement; After-pains; Diet after Confinement; Occasional Occur- 
rence of Sickness; Aperients; Discharge; Occasional Excess of Discharge; 
Management; Necessity of Cleanliness; Methods of Douching and Syring- 
ing; Maintenance of Eecumbent Position; Summary of Normal Progress; 
Application of Binder; Alteration of Figure after Confinement; Desquama- 
tion of Skin; Deepening of Color of Hair; Occasional Occurrence of Fever- 
ishness; Necessity of Medical Aid; Susceptibility to Infection during 
Convalescence. 

CHAPTER X. 

The Mother in Relation to the Infant , 86 

Duty of Mother to Suckle Infant; Occasional Exceptions; Normal Secretion 
of Milk; Importance of Commencing Suckling soon after Confinement; Pro- 
cess of Sucking; Flatness of Nipple ; Management; Breast-Pump; Employ- 
ment of Older Baby: Soreness of Nipple; Fissures of Nipple; Fulness of 
Breasts; Insufficient Flow of Milk; Methods of Increasing Flow; Frequency 
of Sucking; Indications of Discomfort of Baby; Probable Meaning; Ten- 
dency to Painful Digestion; Susceptibility of Infant to Improper Diet and 
Drugs taken by Mother; Tension of Breasts; Localized Hardness and 
Swelling; Abscess of Breast; Relation to Fissures; Importance of Cleanli- 
ness; Objects of Treatment; Question of giving up Nursing; Normal Duia T 
tion of Nursing; Indications pointing to Propriety of Cessation; Symptoms 
due to Over-nursing— Relief of Symptoms; Arrest of Secretion of Milk; 
General Treatment; Local Applications. 



8 LIST OF CONTENTS. 

PART III. 



THE CHILD. 



CHAPTER XI. 

PAGE 

Normal Development op the Child 10i3 

Average Size and Weight at Birth; Variations; Description of Skin; Of Head; 
8utures of Head; Fontanelles; Cry; Grasp; Animal Heat; Necessity of 
Warmth; Tendency to Sleep; Action of Bowels and Kidneys; Meconium; 
Normal Excretion of Bowels; Secretion of Kidneys; Indication of Disorder; 
Recurring Craving for Food; Average Kate of Growth in Height and 
Weight; Increase in Intelligence; Development of Sight and Hearing; 
Tears and Smiles; Amount of Sleep; Process of Teething; Development of 
Walking Powers; Art of Speech; Second Dentition; Absorption of First 
Teeth; Puberty in Girls ; Menstruation; Occasional Discomfort; Necessity 
of Care during Period; Caution in Use of Stimulants; Manifestations of 
Mental and Moral Disorder; Puberty in Boys; Nervous Derangements. 

CHAPTER XII. 

General Care op the Child 120 

Washing of Baby; Temperature of Water; Soaps; Use of Oil; Attention to 
Cord; Dress; Necessity of avoiding Pressure or Restraint; Material of 
Clothing; Diapers; Bassinette; Objection to Baby Sleeping with Mother; 
Desquamation of Skin; Red-Gum; Value of Fresh Air; Sunshine; Daily 
Baths; Value of Douching; Out-Door Exercise; Carriage in Arms; Bassin- 
ette Perambulators; Importance of Support when sitting up; Walking in 
Open Air; Cultivation of Cleanly Habits; Selection of Clothing; Unreliable- 
ness of Children's Sense of Temperature; Indications of Insufficient Cloth- 
ing; Change of Underclothing at Night; Importance of Looseness of 
Clothing. 

CHAPTER XIII. 

The Nutrition op the Child 335 

Mother's Milk the Natural Food; Temporary Substitute when Necessary ; 
Difficulties of Sucking; Frequency; Amount of Milk obtained; Use of one 
or both Breasts; Indications of Discomfort from Excess of Milk taken; 
Progress of Natural Nursing; Insufficiency of Supply of Milk; Necessity of 
Artificial Supplement; Eligible Substitutes; Use of Feeding-bottle; Tem- 
perature of Artificial Food; Farinaceous Foods; Selection; Quantity to be 
given; Occasional Inability to digest diluted Cow's Milk; Alternatives; 
Milk Humanized ; Sterilized; Peptonized; Asses 1 Milk; Goats' Milk; Wet- 
•nurse; Addition of Farinaceous Food; Feeding by Spoon; Addition of 
-Animal Food; Objections to Nerve-stimulants; Common Errors in Diet of 
"Infants; Deficiency of Fat; Excess of Farinaceous Food; Excess of Nitro- 
genous Food ; Irritability of Digestive Organs in Children. 



LIST OP CONTENTS. 9 

CHAPTER XIV. 

PAGE 

Physical and Mental Training of the Child 156 

Object aimed at; Necessity of Training Faculties; Results of Disuse ; Relation 
between Body and Mind; Importance of Maintenance of Health and Devel- 
opment of Function; Variations in Different Children due to Want of 
Training; Dread of Undue Strain; Value of Effort alternating with Rest ; 
Necessity of Care against unduly Severe or Prolonged Strain; Spontaneous 
Tendency to Movement; Artificial Means of Exercise; Swinging; Military 
Drill; Musical Calisthenics; Dancing; Importance of Regularity in Exer- 
cise; Necessity of Due Rest; Training of Special Senses; Mental Training; 
Risk of Overwork; Relation between Fatigue and Want of Interest; Moral 
Training. 

CHAPTER XV. 

Some Congenital Defects in Children 168 

"Mothers' Marks"; Cause; Treatment; Club-Foot; Hair-Lip; Supernumer- 
ary Fingers and Toes; Hernia: Umbilical, Inguinal; Hernia in Middle Line 
of Abdomen; Imperforate Lachrymal Ducts; Liability to be Mistaken for 
Inflammation; Imperfections of Sight; Short-sight; Long-sight; Astigma- 
tism; Squinting; Curability; Detection of Short-sight; Of Astigmatism. 



CHAPTER XVI. 

Hints on Nursing Children during Illness 168 

Duties of a Nurse; Observation of the Patient ; Respiration; Pulse; Tempera- 
ture; The Clinical Thermometer; Hygiene of Sick-room; Cleanliness; Ven- 
tilation, Temperature; Light and Sunshine; Hygiene of Invalid : Cleanli- 
ness; Clothing; Food; Administration and Application of Remedial 
Agents; Mixtures; Powders; External Applications: Warm Fomentations; 
Spongio-piline ; Poultices: Linseed Poultice, Bread Poultice, Starch Poul- 
tice; Application of Dry Heat, of Cold; Compresses; Counter-irritation; 
Stimulating Liniments; Mustard Plasters; Poultices; Turpentine Stoups; 
Medicated Applications; Sedative Liniments; Ointments; Lotions; Syring- 
ing of Ears ; Applications to Throat ; Leeches : Management of Infectious 
Diseases; Disinfectants; Their Abuse. 



CHAPTER XVII. 

Some Minor Troubles of the Earlier Months of Infant Life 192 

Separation of Stump of Umbilical Cord; Occasional Ulceration; Treatment; 
Hernia at Navel; Management; Inflammation of Breasts ; Desquamation 
of Skin; Red-Gum; Jaundice; Yellow-Gum; Thrush: Its Cause and 
Treatment; Diarrhoea; Its Causes and Treatment; Erythema and Inter- 
trigo; Sand or Gravel; Constipation: Its Treatment; Inflammation of Eye- 
lids; Method of Applying Lotions to Eye; Closure of Lachrymal Ducts; 
Vaccination. 



io LIST OF CONTENTS. 

CHAPTER XVIII. 

PAGE 

Some Disorders Associated with the Process of Dentition 210 

Condition of Nervous System during Dentition: Difference of Manifestations 
in First and Second Dentitions; Affections of Gums and Mouth : Ulcers of 
Mouth; Distinction from Thrush; Feverish Attacks ; Restlessness at Night; 
Disorders of Digestion; Treatment; Colic and Diarrhoea ; Cold and Cough : 
False Croup; Bronchial Catarrh; Necessity of Care; Treatment of Cold, 
of False Croup, of Bronchitis; Child-crowing, Treatment; General Con- 
vulsions, Treatment; Abscess of Ear; Treatment; Night Terrors; Other 
Mental Peculiarities. 

CHAPTER XIX. 

Common Maladies of Children 221 

I. Earache and Discharge from Ear. 2. Affections of Throat; Catarrhal In- 
flammation of Throat; Subacute Tonsillitis; Diphtheritic Inflammation; 
Distinction between them : Treatment of Catarrhal Inflammation, of Sub- 
acute Tonsillitis; Precautions Relating to Diphtheria ; Chronic Enlargement 
of Tonsils; Their Effects on Respiration: Snoring. 3. Disorders due to 
Cold or Chill; Cold in the Head, in Throat and Larynx; Bronchitis; Cold 
affecting the Stomach and the Bowels. 4. Disorders of the Digestive Or- 
gans; Indigestion, Acute and Chronic; Diarrhoea; Prolapse of Bowel; 
Constipation; Treatment by Diet, by Injections, by Medicines. 5. Erup- 
tions on the Skin : Heat-spots; Roseola; Nettie-Rash; Eczema. 6. Infec- 
tious Eruptive Fevers: Chicken-pox; Small-pox; Scarlet Fever: 3Ieasles; 
Rotheln; Mumps: Whooping-Cough; Responsibility of Parents in Relation 
to Infectious Diseases. 7. Parasitic Diseases: Ringworm; Itch: Thread- 
worms. 8. Diathetic Diseases: Rheumatism; Scrofula: Rickets. 

CHAPTER XX. 

Management of Some Emergencies 275 

Bruises; Sprains; Burns and Scalds; Incised Wounds; Arrest of Bleeding; 
Lacerated TVounds: Foreign Bodies in Eye; Foreign Bodies in Ear and 
Nose; Bleeding from Nose: Emergency Basket; Contents. 



PART IV. 
LATER MARRIED LIFE. 



CHAPTER XXI. 

The Menopause 282 

Change of Life; Age at which it Occurs; Manner of Occurrence; Discomforts 
attending Menopause; Affections of Head; of Digestion; Mental Irrita- 
bility; Depression of Spirits; Physical Alterations; Occasional "Flood- 
ings''; Treatment of Various Symptoms. 



Index. 




COURTSHIP. 



J. Hamsa. 



TOCOLOGY FOR MOTHERS. 



PART I. 

EARLY MARRIED LIFE. 



CHAPTER I. 

Duties and Responsibilities of Married Life. 

Ignorance before Marriage of Probable Duties and Responsibilities; Impor- 
l "" uce .of Step taken in entering Matrimony ; Necessity of Mutual Self -Sacri- 
fice; Probability ot Maternity; Period of Life during which Maternity may 
Occur ; Possibility of some Suffering during this Period ; Effect of Mother's 
Life and Conduct on Future Health of Child ; Inherited Tendencies ; Les- 
sons from Examples ; Imitative Faculties of Children. 

i 

Every young woman who enters into what are conventionally 
called the " bonds of matrimony " voluntarily accepts certain responsi- 
bilities, and undertakes certain duties, not only important in them- 
selves, but noteworthy also in this, that their neglect and repudiation 
may be followed by far-reaching consequences to others. Convention 
has decreed that those duties and responsibilities should be discovered 
mainly by wives after marriage ; and it is seldom indeed that mothers 
are judicious or enlightened enough to place before their marriageable 
daughters even a partial view of the difficulties and troubles which 
almost every married woman will have to face at some period of her 
married life. Not that one would wish such difficulties to be repre- 
sented as a deterrent from entering a life which to every woman should 
form the ideal of happiness ; but it is certainly desirable that women 
on entering married life should be aware that calls will be made upon 
their courage, their temper, and their forbearance ; and should take 
what is undoubtedly the most decisive step of their lives with some 
knowledge of its importance and gravity, and some sense of the great 

influence which marriage must exercise on all their future career. 

n 



12 EARLY MARRIED LIFE. 

Whatever view one may take of the relative position of the sexes in 
married life, it is obvious that both husband and wife must, to some 
extent, lose the independence of the unmarried state. The law of Eng- 
land, as of most other civilized nations, makes the marriage union 
indissoluble except by death or misconduct ; and married people must 
enter their common life with the full intention of remaining in close 
association for the term of their natural lives. %f this association is to 
be a happy and prosperous one, if their joint life is to be fuller and 
richer after marriage than before, it is absolutely essential that each 
must contribute to the result by careful consideration of the other's 
feelings and wislk©*. and by occasional sacrifice of his or her own incli- 
nation and desires^JNo two human beings ever were born, or probably 
ever will be, wimexactly the same tastes, wishes, desires, and appe- 
tites, just as no two persons ever presented exactly the same type of 
features and expression, and if two agree to lead the same life as 
united in marriage, that life must naturally be to some extent a com- 
promise of their relative inclinations and ideals. One of the first duties, 
then, of married life is to learn to subordinate personal wishes to 
mutual interests. 

In the marriage ceremony of the Church of England, it is stated 
that one of the objects for which marriage is instituted is the begetting 
of children ; and to most, if not all, right-minded women, the pleasures 
of maternity are looked forward to as the highest blessing of married 
life. There is inborn in a woman's mind the love of children, and the 
wish to have children of her own, on whom maternal love can be lav- 
ished ; and as regards the vast majority of married women, this instinct 
and wish are fulfilled. For the larger part of a woman's life, the 
power of reproducing is possessed while in health, and not unfrequently 
even when health is much impaired ; and during the whole period of 
life from fourteen to fifty-four the possibility of bearing children 
exists, although examples at either of these extreme ages are very rare. 
In England, where early marriage is not the rule, it is unusual to find 
mothers at an earlier age than eighteen, while it is almost equally 
exceptional for women to have children after forty-six years of age. 

Great, however, as is the pleasure and the comfort of possessing 
children, and valuable as is the solace of their love and affection, their 
possession is not usually attained without some suffering and self-sacri- 
fice on the part of the mother. From the very commencement of preg- 
nancy, it is necessary for the future mother to pay some attention to 
the results which her life and conduct may have on the welfare of the 
child she is about to bring into existence. Irresistible evidence is plen- 
tiful that both the physical and mental health of children depend 
greatly upon the characteristics which they inherit from their parents, 
and perhaps more especially from their mothers. To mention only very 



EARLY MARRIED LIFE. 



13 



well-marked inherited tendencies, it is a matter of daily observation 
that undue indulgence in alcoholic beverages shows its effects in chil- 
dren — not only in a craving for alcohol, but also in various diseases of 
the nervous system, such as epilepsy and hysteria, and even idiocy. 

No diseases are more readily transmitted to children than those of 
the nervous system ; and want of control in the mother, resulting in fits 
of passion and hysterical attacks, may not unfrequently manifest them- 
selves in children in the more marked forms of epilepsy and insanity. 
So that the duty of all thoughtful persons likely to become mothers is 
indicated most plainly. Careful regulation of daily life, abstinence 
from excesses of any kind, and, as far as possible, the avoidance of 
severe strains upon the nervous system, are of the greatest possible im- 
portance in view of the object most desired by a right-minded wife — 
the bearing of a healthy infant. 

But not only by these more obvious and prominent departures 
from healthy life is the future of a child imperilled. There can be 
little doubt that even slighter ailments which may be acquired by the 
mother are sometimes transmitted to the child. It is not uncommon 
to remark in children a tendency to indigestion and irritation of the 
stomach, which may be traced to the presence of dyspepsia in the 
mother, induced by improper diet and undue indulgence in indigestible 
foods. One of the most fatal inheritances of children in any country is 
the tendency to rheumatism, which often leads in early life to inflam- 
matory diseases of the heart, as well as to painful affections of the 
joints. Illnesses of this character in childhood frequently produce 
results of which the injurious effects are apparent throughout the whole 
duration of life ; and even such apparently unimportant defects as 
slight imperfections of the eyes, showing themselves in short-sighted- 
ness or long-sightedness, seem capable of being transmitted to one's 
offspring. It seems probable, indeed, that minor mental imperfections 
— such as irritability, and angry passion, and deceit — may be trans- 
mitted in a similar manner, although the proof is more difficult ; and 
the probability is strengthened by consideration of the frequency with 
which tricks of manner, and peculiarities of expression, are repeated in 
children even where the possibility of imitation has been excluded by 
separation. 

Thoughtful consideration of these facts will impress upon every 
married woman the responsibility which rests upon her to regulate her 
conduct and life in such a way that her offspring may not suffer in any 
manner from her indiscretion or carelessness. To any one possessing a 
sense of right feeling, it would be a matter of life-long regret that a 
child has suffered from any cause which a little care exercised at the 
proper time might have entirely prevented ; and the remorse would be 
intensified by the consideration that inherited taints of the character 



H 



EARLY MARRIED LIFE. 



indicated do not necessarily limit themselves to one generation, but 
may not unfrequently be traced through three or four successive 
families. 

The position of responsibility, moreover, does not end with the 
birth of the child. Although there is room for doubt whether any 
mental characteristics are actually absorbed, in the popular phrase, 
"with the mother's milk," there can be no doubt that, from a very 
early stage in its career, every child possesses more or less an imitative 
power, and will acquire from its mother habits of speech and conduct, 
very much sooner than is usually supposed. Outbursts of petulant 
anger, the use of improper language, or unseemly levity of conduct, 
will often produce on the young mind impressions which may react to 
its disadvantage and injury in later years ; while, on the other hand, 
dignified control of temper and gentle manners will be imitated in early 
childhood, and impress permanently the character in after life. 

Many considerations of a similar nature might be adduced to illus- 
trate the influence which maternal characteristics may have upon chil- 
dren ; but enough has been said to impress upon all expectant mothers 
the propriety and desirability of conscientiously regulating their con- 
duct during pregnancy and in motherhood, so that right impulses and 
healthy energies should spread outward in an increasing wave through 
successive generations. 

It is related, in the life of the Rev. Charles Kingsley, that when his 
mother became aware that she was about to bear a child, she firmly 
resolved that during her pregnancy she would allow no external 
troubles to influence her mind, and that, living in a beautiful country, 
she would give up as much time as possible to the contemplation of 
natural beauty and to admiration of the works of the Almighty ; and 
it is easy to believe that the thorough sympathy with Nature, and the 
earnest humanity which characterized the author of "The Water 
Babies " and " Yeast," were due in great measure to the mental attitude 
of his mother during the months preceding his birth. Every mother 
cannot carry out these principles to the same extent ; but it is possible 
for every expectant mother to look, as far as may be, rather to the 
future happiness of motherhood than to the present discomforts of 
pregnancy ; to feel that in becoming a mother she is fulfilling a duty 
high and important ; and to the best of her ability to contemplate the 
brighter side of the picture, encouraged by the constantly nearing 
approach of maternal joy. 



CHAPTER II. 



Altered Conditions or Life after Marriage. 

Change in the Circumstances of the Wife; Loss of Family Ties; Formation of 
New Friendships; Utilization of Leisure Hours; Importance of Out-door 
Exercise; Various Forms of Exercise; Value of Motive in "Walking; Care 
in Diet; Duty of Taking Proper Care of Health; Place of Alcoholic Stimu- 
lants in Diet; Injurious Effects of Improper Use of Stimulants on Mother 
and Child; Mental Occupation; Tendency to Occasional Depression; 
Methods of Relief; Domestic Troubles ; Rule for Avoiding Worry. 

Marriage is followed by a very much greater change in the circum- 
stances and habits of the wife than in those of the husband. The latter 
still pursues the daily occupation to which he has been accustomed for 
ye'ars, one-third at least of his time probably being devoted to the 
claims of his profession or business ; and, in general, he is still sur- 
rounded by his old friends, and to some extent is able to participate in 
his usual recreations. On the other hand, the wife will most commonly 
find herself in a completely novel position. Her family ties are more 
completely broken, and the occupations of girlhood are exchanged for 
the more responsible duties of housekeeping ; while she will often find 
herself separated by distance from old friends, and under the necessity 
of creating a new circle of friends and acquaintances in her more 
immediate neighborhood. It is impossible that such a change can be 
suddenly effected without more or less discomfort and annoyance. 

To many women, even when young, the making of new friendships 
is a difficult and slow process ; and the difficulty is one which generally 
increases with progressing years. Yet, to most young married women, 
the companionship of at least a few friends is very desirable, if not abso- 
lutely necessary, for the maintenance of health. The general condi- 
tions of social life generally render it a necessary misfortune, for all 
but the very wealthy, that the husband should be absent from home for 
many hours daily in the pursuit of his business ; and even with the 
occupation and excitement to which early adventures in housekeeping 
may give rise, there must often be many lonely and occasionally weary 
hours for the wives who are left at home. It is a duty which a wife 
owes to her husband as well as to her health to make je very effort to 
use well these solitary hours. 



1 6 EARLY MARRIED LIFE. 

A very co mm on fai mong :hose whose life is spent 

in large towns, is the tendency to lead too sedentary a life, and to 
negl set the vgular outdoor exercise which is indispensable to good 
health. X o fact in physiology is more clearly proved than the necessity 
of physical exercise of some kind, if health is to be maintained in m 

factory condition. The form that the exercise may take is of minor 
importance. To those who can afford it, riding on horseback is a very 
greeable and most valuable form ; and bicycle riding is within the 
reach of many who cannot afford the luxury of a living steed. There 
is no reason to suppose that any injury can result to a healthy woman 
by tricycling in moderation ; and one of its advantages is that the 
pleasure can often be shared -by one's husband, as tandem tricycling is 
even more easy than single riding, if the two riders are accustomed to 
each other's action. To those who live in the neighborhood of rivers, 
or at the seaside, rowing, and more especially sculling, is an equally 
lelightful and useful mode of exercise, and one very well suited to 
young women who are sensible enough to wear a dress suitable for the 
purpose. 

The majority of young married women will however, probably 
have to content themselves with walking exercise. It is frequently 
asked how much walking exercise should be undertaken daily ; and the 
question is one to which it is impossible to give a definite answer. 
Much de;: ::on the temperament, the strength, and the nervous 

energy of the inquirer, as well as upon the circumstances under which 
the exercise ia taken. It is a matter of daily observation that one can 
walk much farther with less fatigue if one has an interesting compan- 
ion, or a special object in view. It may be said generally that most 
women would be the better for walking at least three or four miles 

-. while many are quite able to enjoy thoroughly and benefit by a 

_ of six or eight miles. If no special motive for walking exists, it 
- »ften well : invent one. Dealing with shops at some distance from 

: home sometimes offers an inducement for exercise ; or visiting 

friends at some distance from one's residence may be a convenient 

motive. The main point is to avoid wha: is sometimes called "taking 

aonstitntlonal, " a proceeding which is very unlikely to have the 

red effect in promoting health. 

In addition to regularity of exercise, regularity of diet is of prime 
importance to the maintenance of good health in early married life. It 
is, however, a duty which is rather apt to be neglected. "Women are 
sometimes inclined to think that there is a certain amount of selfishness 
in considering their own wants in the absence of their husbands ; and 

sad of taking regular and proper meals, to temporize with some 
substitute, such as tea, which, while it stimulates and removes tempor- 
arily the sense of fatigue and hunger, really affords nothing that can 



EARLY MARRIED LIFE. 



17 



properly be termed food. There is no real selfishness in supplying 
mie's wants in such a way as to maintain one's self in good health ; and 
it is a duty women owe to their husbands to regulate their lives so as to 
be fit companions for them, and healthy mothers for their children. 
To women who breakfast early, and whose evening meal is late, it is 
most essential to have a proper substantial meal in the middle of the 
day, of which a part should consist of some kind of meat or fish. 

Effect of Stimulants. — Young women should especially be care- 
ful to avoid acquiring the habit of taking any alcoholic fluids to supply 
the place of more valuable food. The proper place of alcoholic stimu- 
lants, so far as they may be required or taken at all, is as an adjuvant 
to the more solid meals of the day ; and, even then, they should only 
be taken in very moderate quantity. Probably the majority of women 
will enjoy better health while abstaining from all alcoholic drinks ; but 
even in cases where the digestion is assisted and health improved by 
a little wine or beer taken with meals, an invariable rule should be 
adopted that no stimulants be taken at any other time without direct 
medical sanction or recommendation. Irregular stimulant-drinking is 
not only directly injurious in many ways, but also the indirect cause of 
many maladies, more especially of the nervous system, and is exceed- 
ingly apt to lead to permanent habits of inebriety. Considerable expe- 
rience has shown that this practice is one of the most fertile causes of 
unhappy married life ; while conclusive evidence proves its injurious 
effect upon the health of the offspring. 

Health of the Mind. — While due attention is given to the mate- 
rial requirements of the body, another equally important condition of 
health is the maintenance of the mind in properly regulated employment. 
Real health is only obtainable when both the mind and the body are 
kept in satisfactory condition by active exercise. It. is no uncommon 
thing for young women after marriage to give up the occupations of 
the leisure which they enjoyed before other interests occupied their 
attention ; and when the novelty of the altered life has somewhat faded, 
it is not unfrequent to observe mental depression, and occasional ten- 
dency to hysteria, as the result of a sense of loneliness and absence of 
interesting intellectual resource. Commencing in this way, the depres- 
sion may and often does lead eventually to indigestion, and sleeplessness, 
and manifests itself externally in irritability and unhappiness. It is 
very desirable that young married women should have at least one 
mental resource upon which they can fall back when irritated by the 
troubles of housekeeping, or when suffering from the ennui resulting 
from separation from old friends. Whether that resource be music, 
reading, singing, drawing, or any other so-called accomplishment, it 
should be cultivated with assiduity and regularity ; for of all these it 
may be said that the pleasure derived from them increases with prac- 



1 8 EARLY MARRIED LIFE. 

tice and use, and decreases with neglect. Both in earlier and later life, 
wc shall reap the reward of some self-sacrifice in the practice of pur- 
suits which both afford pleasure and extend and cultivate our mental 
resources. 

Minor Troubles of Life — Every young woman who commences 
housekeeping on even a very moderate scale must expect to encounter 
a certain number of troubles and worries. She has, in many cases, to 
enter into relations with others in a sphere rather different from her 
own, and it is impossible that without experience she can realize and 
understand their point of view, just as it is very unlikely that they will 
understand or appreciate hers. It is most necessary for her peace of 
mind that she should perceive that there are usually at least two points 
of view from which things can be regarded ; and that her own is not 
necessarily the right, still less the only one. And while, naturally, we 
all prefer our own view, it is very foolish to be annoyed because other 
people prefer theirs. A golden rule which will often save us from 
petty worries is — to strive resolutely to allow only our own conduct to 
affect our mental condition ; to rest satisfied with doing our very best ; 
and having done this, to disregard, as far as possible, the failure of 
others to attain our own particular standard. It has been remarked 
that there are two classes of circumstances in life which should never 
be allowed to annoy us : those circumstances that can be helped, and 
those that cannot ; the former, being under our own control, may be 
obviated, and the latter, being beyond our control, should be disre- 
garded. Oliver Wendell Holmes, in one of his works, remarks that the 
human "race might be divided into the "Ifs" and the " Ases," the 
"Jfs" being those who desire unattainable conditions for their hap- 
piness, and the "Ases" those who accept facts as they are and make 
the best of them. Every young woman who wishes to make the best 
of her life should resolve to place herself at once in the latter class. 



CHAPTER III. 



Signs and Symptoms of Pregnancy. 

Their Existence and Import; Plan of Consideration; Cessation of Menstrua- 
tion; Its Significance and Value in Determining Probable Duration of Preg- 
nancy; Normal Duration of Pregnancy; Extreme Limits of Duration; 
Methods of Determining Probable Date of Confinement; Examples. Gas- 
tric Derangements; Morning Sickness; Abnormal Sense of Hunger; Crav- 
ing for Unusual Articles of Diet; Pain in Stomach; Other Disorders of Di- 
gestion. Enlargement of Breasts; Tenderness; Prominence of Veins; 
Secretion of Milk; Enlargement and Pigmentation of Areola; Secondary 
Areola; Quickening and Sensations of Movement of Child; Possibility of 
Mistake in Sensations; External Evidence of Movement; Increase in Size 
of Abdomen; Period at which Noticeable; Conclusion. 

The commencement and progress of pregnancy are usually char- 
acterized by certain external and objective signs, and certain internal 
and subjective symptoms, "which in general are sufficiently pronounced 
to inform the expectant mother with fair certainty both of the condi- 
tion she is in, and of the probable period of its eventuation. Of these 
signs and symptoms some are only occasionally present, but when 
present are of much value ; others are always present, although their 
meaning may occasionally be misinterpreted ; while others again, though 
frequently present, are not of material importance in determining the 
existence of pregnancy, as they often accompany other conditions not 
related to pregnancy. Some of the signs also can only be appreciated 
by a duly qualified medical man ; no mention will be made of such 
indications in the descriptions which follow. In regard to those which 
are described, their value as symptoms, and the frequency with which 
they occur, will as far as possible be pointed out, together with the 
bearing of each on the question as to the period of gestation which may 
have been reached, and the consequent determination of the date at 
which confinement may be anticipated. The consideration of the 
duration of ordinary pregnancy will be better entered upon after the 
first symptom has been described and explained. 

Cessation of Menstruation. — As a general rule, the existence of 
pregnancy is first suggested by the cessation of the usual monthly 
period. While in different women the period of time between the 
so-called "monthly" periods may varv from less than three to more 

19 



20 SIGNS OF PREGNANCY. 

than five weeks, in the same individual the intervals are usually fairly- 
uniform ; and although it is not very uncommon in early married life 
to notice a slight deviation from this regularity, a postponement of the 
monthly period for more than two weeks beyond the ordinary interval 
always suggests at least the possibility of pregnancy, while if entire 
cessation results, in the absence of any other apparent cause, the prob- 
ability of pregnancy is exceedingly strong. In not a few cases, what 
is at first observed is not absolute cessation of the period, but a dimin- 
ished menstrual flow for a shorter time than usual ; and only on the 
following occasion when the period is expected is the menstrual flow 
entirely arrested. 

The value of this sign is considerable. Arrest of the menstrual 
flow, in the absence of illness, and when no chill followed by pain has 
been experienced, is very exceptional in healthy young women ; so 
that when the arrest occurs, unaccompanied by any symptoms of dis- 
ordered health, there is a strong presumption that it is to be referred to 
the existence of pregnancy. Its significance when present is not dimin- 
ished by the fact that a comparatively small number of young women 
continue to have their menstrual period during the first three or four 
months of pregnancy — in some cases certainly rather diminished in 
amount ; while a very few have a periodic colored discharge through 
the whole duration of gestation. Such instances, however, are relatively 
very uncommon. The fact that menstruation usually ceases from the 
commencement of pregnancy, is of great value in enabling one to deter- 
mine the time at which confinement is likely to take place. 

Duration of Pregnancy. — The ordinary duration of pregnancy 
is usually presumed to be from 273 to 280 days, that is, about nine cal- 
endar months, or ten lunar months of 28 days each. There is some 
evidence to show that confinement frequently takes place about what 
would be the tenth menstrual period after the last period before the 
cessation of the menstrual flow, so that women who menstruate rather 
more frequently than every 28 days would probably have a shorter 
period of gestation than those who have longer intervals between the 
monthly periods. Gestation, however, for a much shorter time than 
nine calendar months is exceptional ; and if the duration is more than 
two weeks short of that period, the baby will generally show some 
indications of premature birth. On the other hand, the duration of 
pregnancy beyond 280 days is not at all uncommon ; not very unfre- 
quently gestation is prolonged beyond 300 days, and even in some cases 
as long as 45 or 46 weeks. Such instances are, however, undoubtedly 
rare ; and in the large majority of cases, pregnancy is terminated by 
mature confinement at the end of about 40 weeks. 

For the purpose of determining as accurately as possible the proba- 
ble date of confinement, it is usual to assume that the commencement 



DURATION OF PREGNANCY. 2I 

of pregnancy dates from about one week after the last observed men- 
strual period, the beginning of pregnancy being most likely to occur at 
that time ; and to estimate that confinement will take place not earlier 
than nine calendar months from that date. Thus, if the last menstrual 
period ceased on the 1st of January, one would allow one week from 
that day, and calculate that confinement would occur not earlier than 
the 8th of September. It is generally believed also that, next to one 
week after the menstrual period, pregnancy most commonly commences 
immediately before the menstrual period ; and allowing nine months 
from that date, the calculation would be made that confinement would 
not be later than nine calendar months and three weeks from the cessa- 
tion of the last observed menstrual period. Utilizing the example 
given above, and assuming that an individual menstruated every 28 
days, if the last menstruation terminated on January 1st, the next 
would have been expected on January 29th ; and on the assumption that 
pregnancy may have commenced two days before that date, it would 
be concluded that the pregnancy might not be determined by confine- 
ment before the 27th of September. Since, however, the pregnancy 
may begin at any time between the menstrual periods, the date of con- 
finement would lie approximately between the 8th and 27th of Septem- 
ber, with the possibility of occurring even one week earlier ; and in 
most cases this approximation of dates is the greatest degree of cer- 
tainty which can be reached, at least when it is a first pregnancy that 
is in question. In later pregnancies, a greater degree of certainty 
can frequently be attained, from the fact that successive pregnancies 
are apt to follow the same course as to duration and period of com- 
mencement. In regard to the probability of the later or earlier date 
being the true one, there seems some evidence to show that where there 
has been a slight and exceptionally small menstrual period last ob- 
served, the pregnancy may date from immediately before it ; whereas, 
when the last observed period has been one of usual character, the 
probability will be that pregnancy commenced within a week after it. 
In other words, when pregnancy commences immediately before a 
menstrual period, the period is not always entirely prevented, but is 
diminished in duration and amount. This, however, is not by any 
means invariable ; and it is generally safer, in making arrangements for 
a confinement, to assume that it may occur on any day after the date 
calculated from the week succeeding the last ordinary menstrual period. 

In the exceptional instances where menstruation is not arrested 
during pregnancy, the difficulty of estimating the probable date of con- 
finement is considerably increased, and an equal degree of accuracy is 
not usually obtainable ; although considerable assistance in the calcu- 
lation is not unfrequently derived from the symptoms we are next to 
consider, as well as from others to be described farther on. 



22 SIGNS OF PREGNANCY 

Gastric Derangements of Pregnancy.— Very few women go 
through the whole course of a first pregnancy without some disturb- 
ances of health referable to the stomach and other organs of digestion ; 
and in later pregnancies also affections of this character are of very 
frequent occurrence. The more usual gastric derangements are, morn- 
ing sickness, abnormal hunger, cravings for unwonted articles of diet, 
and pain in the stomach. 

i. Horning Sickness. — The most common form observed is that 
of a feeling of sickness on rising from bed in the morning, resulting in 
a few minutes in some amount of retching. With some the sensation 
only lasts for two or three minutes in all, and may pass off without 
any retching or vomiting ; with others the sense of sickness may be 
not only severe, but accompanied by retching and vomiting of watery 
mucus for a period extending from fifteen minutes to half an hour. 
General!}' speaking, this symptom, if it occurs at all, occurs at a very 
early stage of pregnancy, not unfrequently showing itself even in the 
first week, so that it may precede in date of appearance the cessation of 
menstruation described in the previous section. "When it has once 
commenced, it is apt to recur every day under similar circumstances 
for some little time, often lasting during the whole of the first three 
months of pregnancy ; in come cases it continues, with perhaps occa- 
sional remissions, during the whole pregnancy, but these are exceptional. 
The intensity and duration of the retching will usually vary from day 
to day, and a day or two may elapse when no sickness is present ; but 
even then a slight sense of nausea is usually experienced for a little 
time. 

As an early symptom of pregnancy, this indication is very valuable, 
for the character of the retching is different from anything that occurs 
in ordinary health. Sickness of a similar kind is common in some 
severe affections of the stomach, and in persons prone to alcoholic 
excess ; but the peculiar combination of morning sickness without any 
other apparent affection of the stomach, and with good health enjoj'ed 
during the rest of the day, is strongly indicative of pregnancy. As an 
indication of the probable period of confinement, the fact of its usual 
commencement within six weeks of the beginning of pregnancy affords 
approximate evidence ; while in the instances in which it is experienced 
before the cessation of the menstrual period, the dates of the com- 
mencement of pregnancy and the probable time of confinement can 
usually be fixed within one or two weeks. In some cases, where morn- 
ing sickness has commenced within one week after a normal menstrual 
period, the beginning of the pregnancy can be certainly estimated 
within two or three days' range. ^ 

2. Abnormal Sense of Hunger and Craving for Food is 
another form of disorder of digestion somewhat characteristic of preg- 



CRAVINGS IN PREGNANCY. 23 

nancy. This seDsation, which may be present contemporaneously with 
morning sickness, or may exist in the absence of the latter symptom, is 
generally observed in the form of sudden accesses of hunger at irreg- 
ular periods throughout the day, and occasionally also during the 
night, temporarily relieved by partaking of a small quantity of food. 
The hunger is exceptional in its characteristics — viz., frequent recur- 
rence, and relief by a smaller quantity of food than would ordinarily 
satisfy a hungry person. In not a few cases, indeed, the sensation of 
hunger is succeeded on commencing to eat by an early sense of reple- 
tion, and sometimes even by actual nausea. Sometimes the sensation 
is described as a feeling of faintness rather than hunger ; in that form 
also it is generally temporarily relieved by taking food. 

3. Cravings for Unwonted Articles of Food. — A third form 
of disordered digestion is seen in cravings for unusual and often un- 
wholesome articles of diet. Women who have been accustomed to 
plain and regular diet occasionally have longings for articles of food 
which they have not been in the habit of indulging in, and which they 
have even formerly disliked. More especially is observed a frequent 
craving for rather highly flavored articles of diet, such as rich ripe 
cheese, pickles, smoked fish, etc. 

4, Pain in the Stomach is an unfrequent symptom, and, when 
it is observed in the absence of sickness, usually takes the form of acute 
pain immediately following the taking of food. It is sometimes of a 
very acute character, resembling neuralgia, and can be relieved by the 
artificial induction of vomiting. 

The second and third forms of gastric disturbance just described are 
of considerable value in determining the existence of pregnancy, as they 
do not usually characterize or accompany ordinary types of indigestion, 
or more serious maladies of the stomach. With regard to the period of 
pregnancy attained, they do not give any very valuable information, as 
they are not uncommonly found at any time during the whole nine 
months of pregnancy ; but, considered in connection with other signs 
and symptoms present, they occasionally give some assistance in deter- 
mining the probable date of confinement. The fourth form mentioned 
(pain in the stomach) is not reliable as a symptom, since it not unfre- 
quently accompanies different diseases of the stomach, and has no 
exceptional character when present in cases of pregnancy. Other dis- 
orders of digestion, such as discomfort, sense of fulness, heartburn, 
and vomiting at other times than on rising in the morning, are not of 
sufficient significance to be dealt with as symptoms of pregnancy, and 
will be mentioned more suitably in a future chapter (on the discomforts 
of pregnancy and their treatment). In closing this section, however, it 
may be added that martfld sensations of sickness, and, still more- 
attacks of retching and vomiting occurring irregularly at any period of 



2^ X SIGNS OF PREGNANCY. 

the-flay,. and without. an y. relation to the hours of-takteg food, always 
suggest the possibility of .pregnancy,, in. the absence. of any illness 
which :might otherwise account for thorn. 

Enlargement of Breasts.— In most young women, either a few 
days 'before, or else during the menstrual period, the breasts become 
somewhat fuller and larger ; and this temporary increase of size is 
often attended with some degree of tenderness. It is generally found 
that, shortly after the commencement of pregnancy, this enlargement 
and fulness not only remain permanently, but even tend gradually to 
increase ; while any tenderness which may have formerly been asso- 
ciated with the fulness usually disappears. The fulness is further 
accompanied and characterized by a feeling of greater firmness, and a 
sense of increased resistance on gentle pressure. Often also there is an 
apparent increase in size of the blue veins which are seen under the 
skin covering the breast, and veins which were not apparent before 
become markedly prominent on the surface, both of the breasts them- 
selves, and of the bust in the vicinity of the breasts. The nipples also 
sometimes become rather larger and more prominent, and occasionally 
in some cases discharge a little watery fluid or even milk. The symp- 
tom is sometimes accompanied by shooting pains, and sometimes by 
throbbing in the breasts ; but much pain or discomfort of this kind is 
rare. As a sign of pregnancy it occurs early, the enlargement being 
often noticeable from the first month, and its presence will strengthen 
considerably the evidence afforded by any other symptoms wrhich may 
be present. The time at which it occurs, however, is not sufficiently 
uniform for it to be of value as an indication of the date of the preg- 
nancy. A sign closely allied to this now to be described affords more 
valuable information. 

Enlargement and Pigmentation of Areola of Breasts.— The 
color of the skin in a circular area of varying size round the nipples 
differs from that of the rest of the breast. This exceptionally colored 
circle, which varies in diameter in different women — in some measuring 
only about one inch from side to side, in others about two inches — is 
known as the areola of the breast. In fair women the color is usually 
a very light pink, while in those of darker complexion it may vary 
from a bright red to a pale brown color, being usually darkest in 
women with black hair. Occasionally, small projecting prominences 
about the size of the head of a pin are observable here and there within 
the areola ; these are the orifices of glands of the skin. 

In the course of pregnancy this areola very generally becomes both 
larger in circumference and deeper in color. Both these results are 
more conspicuous in women of dark complexion, the color of the 
areola being already more defined before the commencement of preg- 
nancy. ; but the increase in size is often very noticeable even in women 



CHANGES IN THE BREASTS. 25 

of 4»arkedly fair complexion. The alteration is accompanied frequently 
by some enlargement and increased prominence of the glands of the 
skin referred to above. The enlargement of the areola and the deep- 
ened color can often be distinguished by the end of the second 
month of pregnancy ; and after three months have elapsed from the 
commencement, they are, except in a few fair women, very distinct. 
As a sign of existing pregnancy, the areola is only of moderate impor- 
tance, as similar conditions are observed occasionally in connection 
with some forms of disease ; but when it occurs in good health, and in 
combination with other signs described, its presence materially strength- 

Fig. 1. 




SHOWING CHANGE IN THE AREOLA AND NIPPLE DURING PREGNANCY. 

ens the certainty. Conclusions of fair accuracy also may be arrived at 
from this sign of the stage of pregnancy reached, if it is considered 
along with the sign about to be described. [A plate of color illustra- 
tions comparing the virgin breasts with those of early pregnancy may 
be seen in Chapter II. of "Plain Home Talk."] 

Secondary Areola of the Breast.— Between four and five 
months after pregnancy commences, in most women who are not excep- 
tionally fair in complexion, a slightly discolored ring develops just 
outside the areola. It is of paler color than the areola, shading it off, 
as it were, into the normally colored skin of the breast ; and varies in 
breadth from half an inch to an inch and a half or more. Its most 
characteristic peculiarity is, that the coloration is not uniform as in 
the areola, but mottled — just as if drops of water had fallen here and 



26 SIGNS OF PREGNANCY. 

there on the surface, and partially washed off the color. The appear- 
ance is somewhat striking, and is peculiar to pregnancy ; so that, when 
well marked, it may be accepted as a certain indication ; and the 
period of pregnancy at which it appears is fairly uniform. All the 
three signs described above relating to the breasts remain after devel- 
opment until the termination by delivery, and the increased color 
frequently remains long afterwards. Often, indeed, the color of 
the areola never in after life regains its original paleness and 
softness. 

Quickening and other Sensations of Movement of the Child. 
— By the term "quickening" is meant the first perception by the 
mother of the movement of the infant in her womb. From a very 
early period of its existence in the womb, the child possesses some 
power of movement ; but during the first one or two months of preg- 
nancy the movements are so feeble and slight as to be imperceptible to 
the mother. The movements apparently consist at first chiefly of 
motions of the legs in straightening and bending them ; and are per- 
formed so quickly as to have the character of kicking. As the growth 
of the child progresses, there are movements of the arms also, and 
rolling or tumbling about of the whole body within the fluid in which 
it is immersed in the interior of the womb. With many women the 
first experience of this movement has a very marked character, some- 
times exciting- sudden faintness, sometimes a tendency to hysteria, 
sometimes a sensation of indescribable nature, almost amounting to pain ; 
in each variety differing from anything which has been experienced 
before. Other women, again, feel nothing at first beyond what is often 
described as an internal "fluttering," as if a small bird were moving 
its wings within the body. In some cases of this kind, the sensation is 
so very little perceptible at first, that the mother cannot fix definitely 
the date at which it was first recognized ; while in others the first per- 
ception is striking, and clearly appreciable. The date of pregnancy at 
which this first impression of movement of the child occurs is some- 
what variable. In the majority of cases it is not experienced before 
the end of the fourth month, and a common period of its occurrence is 
after the lapse of four and a half months from the commencement of 
pregnancy, thus indicating that the middle of the period of gestation 
has been attained. But in not a few instances it is experienced at a 
considerably earlier time ; at any time after three months of gestation 
it may be looked for ; and a few women, more especially in second or 
later pregnancies, are conscious of movements shortly after the end of 
the second month has been reached. On the other hand, some women 
are never conscious of the movements of the child during the whole 
course of pregnancy, although to a doctor examining them the move- 
ments may be perfectly apparent. 



MOVEMENTS OF THE CHILD. 



27 



After the first sensation of movement has been felt, it is usual to 
be conscious of similar feelings throughout the whole of the remainder 
of gestation. The movements of the child become progressively 
stronger as it grows within the womb, and the sensations consequently 
more apparent. They may be felt only at long intervals, days some- 
times elapsing without much appreciable movement, or they may be 
almost continuously present. 

It is probable that only the more violent movements of the child 
are felt by the mother, and that almost constantly slighter movements 
are going on of which she is not cognizant. But different children 
certainly vary very considerably as to the amount of notice they 
attract to themselves in this way ; and conversely different mothers 
present striking contrasts in the extent to which they are incommoded 
by these movements. After six or seven months have elapsed, the 
movements can often be seen in. the changes of projection they produce 
on the surface of the abdomen ; and they can be felt very distinctly by 
the hand placed flatly against the skin over the womb. When the 
movements are at all marked, they afford an absolutely certain indica- 
tion of the presence of a living child in the womb ; and even when not 
very well marked, they are not apt to be mistaken for anything else. 
It must be conceded, however, that not unfrequently women very 
anxious for children are prone to imagine that they feel movements, 
even in the absence of any pregnancy. 

The indication of the period of gestation reached is only moder- 
ately reliable, as the first sensation of movement may be felt at any 
time between the third month and the date of confinement ; but, read 
along with the following sign, a considerably greater degree of accuracy 
can be reached. 

Increase in Size of Abdomen.— In most women during the first 
three months of pregnancy, no increase of size whatever is observable ; 
in fact, in not a few there is an apparent slight diminution in the usual 
curve of the abdominal walls. The reason of this is that during the 
first three months of pregnancy the womb lies below the level of the 
lower part of the abdomen, only rising above this between the third 
and fourth months. At that stage, unless women are exceptionally 
stout, there is usually noticeable a slight increase in fulness and size, 
in well-nourished women fairly uniform over the whole of the lower 
part, in thin women, projecting more in the middle and less at the 
sides. In thin women generally the projection can be felt as a distinct 
oval swelling at the lower part of the abdomen, varying in size at the 
end of the fourth month from a cricket-ball to an ostrich's egg. 

After the increase in size has once become apparent, it progresses 
pretty uniformly, and very obviously ; so that by the end of the sixth 
month of gestation the fulness extends quite up to the navel, and the 



28 SIGNS OF PREGNANCY. 

prominence of the abdomen is marked. The increase in size is caused 
not only by the continual growth of the infant, but also by an increase 
in the quantity of the fluid which surrounds the child inside the womb. 
Variations in size in different women depend largely upon variations in 
the quantity of this fluid ; but, in addition to this, the different figures 
of women undoubtedly result in great differences in the amount of vis- 
ible enlargement. During the seventh and eighth months, the figure 
continues to enlarge, the projection rising higher in the abdomen until 
it reaches the foot of the chest, where the ribs end, and there is usually 
some increase in breadth from side to side, so that even when seen from 
behind, an increase in size is observable. In the last month of preg- 
nancy, increase of size is not so marked ; and frequently there is an 
apparent diminution by a slight lowering of the whole projection, the 
womb, about three weeks before confinement takes place, usually fall- 
ing downwards a little within the abdomen. 

Increase of size alone is, of course, a very uncertain sign of preg- 
nancy, as it may arise from many other conditions ; but, in combina- 
tion with the other signs and symptoms described above, or with even 
one or two of them, it is fairly diagnostic of pregnancy. When move 
ments of the child are distinctly appreciated, the apparent extent of 
enlargement gives evidence of the probable date of confinement within 
a range of six weeks at the outside ; and in many cases a doctor car. 
foretell, by one or two examinations of size at intervals, much more 
accurately than this the date of the termination of pregnancy. 

This concludes the list of signs and symptoms of which it is desir- 
able that every married woman should be cognizant. It is hardly 
necessary to add that in many cases of pregnancy some of them will 
not be present, while others are liable to be misunderstood ; and when 
a doubt exists, and a desire for certainty in the matter is felt, a trained 
medical man is able not only to appreciate at their proper value the 
signs which may be apparent to the expectant mother, but also to dis 
cover and elicit others which may often be sufficient to place the ques- 
tion beyond doubt. 




MOTHERHOOD. 



Eugene Klimsch. 



CHAPTER IV. 



Management of Unpleasant Disorders of Pregnancy. 

Nausea and Sickness; Alleviation by Tea; Breakfast in Bed; Effervescing 
Drinks; Care in Diet; Heartburn; Temporary Means of Relief; Water 
Brash; Dietary for Disorders of Digestion in Pregnancy; Constipation; 
Alleviation by Diet; Regular Habits; Drugs; Warm Water; Mineral 
Waters; Salts; Sulphur; Licorice Powder; Senna; Enemas; Method of 
Administration; Injection of Glycerine; Special Syringe desirable; Selec- 
tion of Remedy; Faintness; Remedies; Caution respecting Stimulants; In- 
crease in Size and Sense of Weight; Arrangement of Clothing; Use of Cor- 
sets; Supporting Belts; Stretching of Skin of Abdomen and Breasts; Cause; 
Results; Pigmentation; Prevention; Alleviation; Swelling of Feet and 
Legs; Alleviation; Distention of Veins of Legs; Two Forms; Description; 
Hereditary Tendency; Treatment; Piles, Internal and External; Treat- 
ment; Vaginal Discharge and Irritation; Alleviation; Use of Injections; 
Precautions; Bathing; Sleeplessness; Causes; Remedies; Caution against 
Use of Narcotics. 

Horning Sickness. — The most usual discomfort associated with 
pregnancy is the morning nausea and sickness, which is fully described 
in the preceding chapter. This unpleasant symptom is often much 
alleviated and sometimes altogether removed by taking a cup of tea or 
of milk in bed before rising. When this is not sufficient, remaining in 
bed until about an hour after the usual breakfast will often be found 
useful. Effervescing drinks, taken just before rising, are sometimes of 
much value ; a little soda or seltzer water, or, when constipation is 
present, effervescing citrate of magnesia or other similar preparation, 
may be employed. When the sickness tends to recur throughout the 
day, as well as in the morning, considerable care in diet is necessary. 
Foods difficult of digestion, such as pastry, cheese, and root vegetables 
as potatoes, carrots, or turnips, must be either given up altogether, or 
only taken in great moderation ; and as a rule the use of all alcoholic 
beverages, and especially beer or ale, should be temporarily abandoned. 
While suffering from this affection, most women will find that a rather 
dry diet, consisting of whitefish, poultry, game, milk puddings, and 
stewed fruits will agree best with them ; while much fluid of any kind, 
even tea and soups, will increase their discomfort. It will be found 
generally advisable to make the principal meal in the middle of the 
day, and to take only a very light meal in the evening. This will be 

29 



30 DISORDERS OF PREGNANCY. 



» 



found particularly important where heartburn complicates and accom- 
panies the sickness and indigestion. 

[When nausea becomes distressing or so persistent as to impair 
appetite and endanger nutrition, it is well to resort to medicinal means 
for its alleviation, and in all but rare cases they can be effectively pre- 
scribed. Dr. Foote can be consulted in person or by letter without fee 
in such matters, or regarding any disturbances of the pregnant state 
when a few words of professional advice may be desired, if a careful 
reading of this work has not enabled the sufferer to obtain a reasonable 
degree of comfort. See page 1226.] 

Heartburn is a sensation of acidity and burning in the pit of the 
stomach, often accompanied by pain radiating through to the back 
between the shoulders ; and frequently attended by the rising into the 
throat, and even into the mouth, of a sour acrid fluid. It is most alle- 
viated by a dry, careful diet, such as is described above ; and is aggra- 
vated by indulgence in much sugar or sweets of any kind, and by alco- 
holic fluids. When heartburn is severe, temporary relief can usually be 
obtained by sipping slowly a solution of bicarbonate of soda in water. 
Half a teaspoonful of powdered bicarbonate of soda should be dissolved 
in half a tumblerful of cold water ; and this should be taken in successive 
teaspoonfuls every two or three minutes until the burning is relieved. 
This is much better and more effective than taking the same quantity 
in one dose. Fluid magnesia, such as Dinneford's, may be sipped in the 
same way as the solution of soda, but is not quite such a harmless or 
efficient remedy. Occasionally, when these remedies fail, a little 
slightly acid fluid is found beneficial. Some patients obtain considerable 
relief from small quantities of lemon-juice in water ; and temporary 
abatement has followed sometimes from eating rather acid apples. 
The latter, however, is not a very desirable remedy from other points 
of view. Powdered chalk in small doses, as much powder as can be 
heaped on a sixpence [dime] being taken as a dose, is occasionally use- 
ful ; but if employed often is apt to cause constipation. 

Water=brash. — Sometimes in the absence of heartburn, a watery 
fluid of a mawkish taste, or sometimes tasteless, is found to rise into 
the throat and mouth, and even to run out of the mouth. This affec- 
tion is known as "water-brash," and is a not unfrequent accompaniment 
of other affections of the stomach, as well as of those connected with 
pregnancy. It is generally alleviated by a diet similar to that which is 
required when suffering from heartburn. Below is appended an out- 
line of diet suitable for invalids suffering from sickness, heartburn, 
water-brash, or from any combination of these affections. 

Dietary during Pregnancy. — 1. Before rising in the morning, a 
small cup of recently infused tea (not allowed to stand for more than 
five minutes) or of milk, either warm or cold. 



DIETARY DURING PREGNANCY. 31 

2. For breakfast, one cup of recently infused tea or coffee made 
with three parts of milk, or thin cocoa, made with equal parts of boil- 
ing milk and water, toast or stale bread, an egg, or a little fresh white 
fish, such as sole, haddock, or whiting. Very little butter should be 
taken, no fresh rolls, or cured fish or meat of any kind. 

3. For midday dinner, any kind of white fish, poultry, game, mut- 
ton, and lamb. Beef should be taken in great moderation, pork not at 
all. As vegetables, cauliflower, spinach, asparagus, and early Brus- 
sels sprouts are the most eligible ; potatoes, turnips, carrots, parsnips, 
and artichokes are to be avoided [if there be any reason to suspect that 
they are difficult of digestion, or a cause of flatulence]. Milk pud- 
dings with a little stewed fruit may follow, but should not have much 
sugar added to them. Uncooked fruits should only be taken in great 
moderation ; the best are grapes, bananas, and perhaps very ripe pears, 
apples, and oranges. 

4. In the evening, a very light meal, consisting at most of a little 
white fish and a milk pudding, will be found most conducive to com- 
fort ; and it should be taken, if possible, at least two hours before 
going to bed. 

5. "When attacks of faintness seem to render it necessary, a small 
tumblerful of milk and a biscuit may be taken between breakfast and 
dinner ; and there is usually no objection to one small cupful of tea in 
the afternoon, preferably with a good deal of milk in it, and accom- 
panied by a plain biscuit or rusk. 

When the regimen indicated above is insufficient to alleviate the 
discomforts of digestion, it will be necessary for the patient to avail 
herself of medical skill ; and fortunately the resources of medicine can 
do much to subdue the more unpleasant manifestations of these gastric 
derangements. In some instances the invalid is obliged to restrict her- 
self for a time entirely to liquid diet ; but this should not be done 
except upon competent medical advice. [On the other hand there are 
cases in which a strictly dry diet, drinking almost nothing with the 
meals, and avoiding sloppy foods, soups, porridges, puddings, etc., 
proves to be a very helpful plan ; and, again, simplicity in diet, or 
limiting the variety of food at any one meal, is another way of keeping 
the stomach quiet and easy.] 

Constipation, or confinement of the bowels, is an exceedingly 
common discomfort, more especially of the earlier part of pregnancy. 
While it is perhaps worse in cases where vomiting is prominent, it is 
frequently present in the absence of any other symptom of disordered 
digestion. Where a healthy condition of the gastric digestion will 
permit of it, much may be done to remove the constipation by a care- 
fully varied selection of diet. Many women find that oatmeal, taken in 
the form of porridge for breakfast, has a distinctly stimulating effect on 



Xi EARLY MARRIED LIFE. 

the bowel ; and it is an article of diet which many appreciate and 
enjoy. Oatmeal may also t^ in the form of oatmeal cakes or 

biscuits at other times. Again, the use in some quantity of green veg- 
etables, snch as cabbage, spinach, Brussels sprouts, or turnip-tops, has 
a strong influence in removing constipation, and assisting regular action 
of the bowels. Stewed fruits also, more especially perhaps figs and 
prunes, are beneficial in this way, and valuable articles of food from 
other points of v: 

It is most important, at the same time that one studies diet for the 
purpose of removing constipation, to make a regular practice of solicit- 
ing an action of the bowels at the same hour every day. and to give a 
sufficient time for this purpose. Just as one acquires a habit of being 
hungry at certain hours of the day associated wil Is, and becom- 

i _- -leepy at an hour associated with rest at one can acquire the habit 
of feeling the want of relief of the bowels at a certain hour ; and the 
habit being acquired, the bowels are more likely to act at that time 
than at any other. There is no doubt that both sickness and heartburn 
during pregnancy are much aggravated by constipation, so that the 
presence of these symptoms is an additional reason for giving both time 
and attention to the due performance of this function of Nature. 

When the diet indicated above, and the regular solicitation of the 
bowels are insufficient to effect the desired result, it is necessary to 
resort to some simple means of stimulating the bowel to increased 
action. This can be done in two ways, either by taking some drug by 
the mouth, which will act on the bowel indirectly ; or by applying 
some stimulus to the interior of the bowel itself. Each method of 
action is eligible under varying circumstances. 

[The 31 Anti-bilious Tablets, No. 3, on list of Sanitary 

Bureau remedies (see page 1228), provide a handy form of gentle laxa- 
tive suitable for use during pregnancy.} 

When there is no troublesome morning sickness, many women find 
that a tumblerful of hot water, taken on rising from bed every morning. 
is sufficient to produce an action of the bowels after breakfast. It 
should be taken as warm as can be comfortably drunk, and should be 
sipped slowly during dressing. The addition of a little fresh lemon- 
juice makes the water certainly more palatable, and probably some 
what more efficacious. When this is not found sufficient, the addition 
of a wine-glassful of one or other of the numerous natural mineral purga- 
tive waters to the tumblerful of warm water, will often be effective and 
not very unpleasant to taste. The ingredients of some of these waters 
are now sold as effervescent salts, which can be added to warm water 
and taken while effervescing. - These are conveniently portable forms 
of the remedies. When sickness in the morning prevents the employ- 
ment of the remedies just mentioned, or when they do not prove effec- 




CONSTIPATION OF PREGNANCY. 33 

tive, some laxative drug may be taken at night ; and among the more 
commonly used of these may be mentioned a teaspoonful of compound 
licorice powder, or of electuary of senna, either of which may be 
taken nightly when required. [Among laxative pills that may be 
recommended Dr. Foote's Magnetic Vegetable Anti-bilious Pills are 
effective, moderate in action, and suitable for constipation during 
pregnancy. See page 1228.] 

When medicines of this nature are ineffective, or when their action 
is accompanied by discomfort or pain, recourse may be had to direct 
stimulation of the lower bowel either by enemas of plain warm water, 
or by injections of glycerine, or by the use of glycerine suppositories. 

Enemas of warm water, while very useful and harmless when 
employed only occasionally, are not eligible for habitual constipation. 
In many circumstances, however, they can be used to give immediate 
relief, and it is desirable for every woman to be familiar with the man- 
ner of their employment. For the administra- 
tion of an enema some kind of syringe is neces- 
sary. The one which is most commonly used 
for this purpose, and which is eligible both on 
account of its low price and the simplicity of its 
construction is known as The Family Enema 
Syringe (see Fig. 2). It consists essentially of an 

" * v ° ' J FAMILY ENEMA SYRINGE. 

india-rubber tube with an enlargement m the 

middle, and a valve near either end which allows of fluid to pass only 
in one direction. The end which, in use, is immersed in the fluid is 
usually slightly weighted ; the other end is a hard rubber or metal 
nozzle, about two inches long. Accompanying the syringe as described 
above, is usually sold an additional longer nozzle made of hard rubber 
which can be slipped on to the rubber tube when the syringe is required 
for other purposes, to be described later on. The price of this syringe 
varies from about one to three dollars, according to the quality of the 
india-rubber of which it is made. [See page 1227.] It is usually sold 
enclosed in a box ; but it is better to keep it lying loosely in a drawer, 
as the curving to which it is subjected in fitting into tbe box is apt in 
time to damage the india-rubber. Its mode of action is very simple. If 
a basin of water be taken, and the end farthest from the nozzle be put 
into the water, by pressing with one hand the enlarged ball in the cen- 
tre and relaxing the pressure two or three times successively, the water 
will be made to circulate through the tube and emerge from the end of 
the nozzle. The rapidity and force with which the stream emerges 
will depend on the amount of pressure applied to the ball, and the fre- 
quency of the alternations of pressure and relaxation. 

In administering an enema the fluid to be injected is put into a 
basin or jug, and the weighted end of the syringe dropped into it. By 



34 DISORDERS OF PREGNANCY. 

one or two acts of pressure and relaxation of the band applied to the 
ball, the syringe is filled with the fluid, until it is seen to begin to 
emerge from the nozzle. The nozzle should be then coated with a 
little vaseline or sweet oil, and gently pushed straight into the entrance 
of the bowel, as far as it will go. There is usually a small collar round 
the top of the nozzle where it joins the india-rubber tubing, and the 
nozzle should be pushed into the bowel until this collar presses against 
the entrance. If the introduction is effected gently, it should produce 
no pain, nor even discomfort. When the nozzle has been inserted, the 
ball of the syringe is compressed and relaxed alternately until the 
whole of the fluid is injected into the bowel. 

The fluid most commonly used as an injection is warm water, of 
such a temperature as can be quite comfortably borne by the hand 
immersed in it. When an injection slightly more stimulating is desired, 
occasionally some soap is rubbed down in the warm water before use. 
Sometimes thin gruel is used as an injection, in combination with a 
wine-glassful of olive-oil, or half that quantity of castor-oil. The 
quantity of fluid used for one injection is usually from a pint to a 
quart ; but occasionally even more than a quart may be injected. It 
will be found that the greater the quantity that can be injected, the 
more efficient the resulting relief of the bowels will be ; and there is 
no risk whatever of injecting loo much, as, when the bowel cannot 
contain what is injected, it will always be pressed out at the side of the 
nozzle before it is withdrawn. The four points requiring attention in 
administering an injection satisfactorily are — 

First, the proper introduction of the nozzle ; 

Second, the slow administration of the fluid ; 

Third, the occasional cessation of administration for a minute or 
two, if it is felt that it is setting up action too quickly ; 

And fourth, the retention, if possible, of the fluid for a few min- 
utes after the nozzle is withdrawn. 

The person receiving the injection will often feel after a small 
quantity has been injected as if it were impossible to retain it or receive 
more ; but in one or two minutes, if the action of the syringe is inter- 
mitted, the bowel will again relax and receive the remainder. When 
as much has been injected as can possibly be retained, the nozzle is 
withdrawn, and the withdrawal is followed almost immediately by 
relief of the contents of the bowel, along with the fluid which has been 
injected. 

Injection of Glycerine. — A very convenient method of obtaining 
action of the bowels without recourse to laxative medicine is found in 
the administration of a little glycerine. It is found that the injection 
of one or two teaspoonfuls of glycerine "Within the entrance of the 
hott-p} is followed usually within ten <->r tiffin minutes by relief of the 



FAINTNESS. 35 

bowels. A special small syringe is necessary for this purpose, as the 
family syringe is scarcely suitable for the injection of such a small 
quantity as one teaspoonful. The most convenient syringe for the pur- 
pose is one made of vulcanite, just large enough to hold the quantity 
required. One such as is illustrated here (Fig. 3) can be obtained from 
any chemist at a very small cost. The syringe is filled by inserting the 
nozzle into the glycerine, and pulling out the piston ; the nozzle is 
then gently pushed into the entrance of the bowel for an inch or more, 
and, by pressing the piston, the glycerine is injected within the bowel. 
Self-administration is very simple and easy ; and as the action of the 
glycerine is that of a local stimulant, there seems to be no objection to 
the frequent repetition of the remedy when called for by constipation. 
It is not, however, equally effective with every one ; while, on the 
other hand, the large injection of fluid with the family syringe is 
always more or less effective ; but as the latter acts chiefly by mechan- 

Fig. 3. 




GLYCERINE SYRINGE. 

ical distention, its too frequent use is apt to be followed by permanent 
weakening and dilatation of the lower end of the bowel. The glycerine, 
instead of being injected by a syringe into the bowel, is occasionally 
made into a gelatinous suppository by the addition of gelatine ; and the 
suppository, coated with olive-oil, is pushed into the entrance of the 
bowel with the finger. In this form also it acts with considerable 
efficacy. 

Faintness. — The occasional sensation of faintness, which not un- 
f requently is experienced in the earlier months of pregnancy, is best 
combated by lying down for a few minutes, and sipping slowly some 
fluid food. Cold water is often quite sufficient for the purpose, the 
essential point being the slow sipping, which acts as a temporary stim- 
ulant to the heart ; but milk, or beef-tea, or soup may be taken when 
preferred. When there is a tendency to hysteria along with the faint- 
ness, half a teaspoonful of aromatic spirits of ammonia in a small wine- 
glassful of water is useful. [It is a prompt acting stimulant which 
does not create a longing for habitual indulgence.] It is most im- 
portant that [alcoholic] stimulants should not be resorted to for the 
relief of this symptom. Although they may temporarily remove it, they 
predispose to its occurrence, and are apt to intensify any other discom- 
forts which may be present, as well as to do injury in other ways, 



36 



DISORDERS OF PREGNANCY. 



Increase in Size, and Sense of Weight.— After the end of the 

third month of pregnancy, a slight increase in size is usually percepti- 
ble, and it is not uncommon to have a sense of having some little weight 
to support. It is most important, from this time onwards, that no 
pressure from undue tightness of clothing should interfere with the 
proper and normal ascent of the womb within the abdomen. Gener- 
ally speaking, corsets can be worn with comfort up to the end of the 
sixth month of pregnancy, if care be taken to adjust them to the size 
required ; and often a well-adjusted corset will afford considerable 
support. But all compression of the waist must be avoided ; and as 
far as possible any heavy clothing worn should be suspended from the 
shoulders rather than from the waist. When anv sense of weight is 



Fig. 4. 



Fig. 5. 





ABDOMINAL CELT.-. 

experienced, much relief and comfort are often obtained from wearing, 
below the corset, a belt which will support the lower part of the abdo- 
men. A sketch is appended of a belt, which fulfils this purpose very 
satisfactorily (Fig. 4). [See page 1227.] 

After the completion of six months of pregnancy, most women will 
find that their comfort is increased by giving up the wearing of cor- 
sets. When a sense of weight, or a dragging at the sides is felt, a belt 
somewhat larger than the one described above will be found helpful. 
A sketch is annexed (Fig. o) of a belt of the shape most useful ; most 
women who have some skill in the use of a needle would be able to make 
one for themselves of similar design, at comparatively little cost. The 
best material of which to make a belt of this kind is either calico, or 
strong towelling ; and the belt should be gored slightly in front to fit 
the figure, and stiffened with one or two strips of thin whalebone, or 
one or two skeins of cotton, inserted between two layers of the mate- 
rial selected. It is generally most convenient to make it fasten at one 



STRETCHING OF SKIN. 37 

side, not at the back, and the best fastening is by straps and buckles. 
Belts of more or less similar character for this purpose are sold by 
almost all surgical instrument makers. 

Stretching of Skin of Abdomen and Breasts. — The elasticity 
of the skin covering the abdomen varies greatly in different women. 
In the later months of pregnancy it is subjected to considerable stretch- 
ing ; and this very frequently results in some alteration in the appear- 
ance of the skin. Whitish lines, from a quarter of an incli to an inch 
broad, of more glistening appearance than the surrounding skin, are 
seen slanting from the sides of the abdomen toward the middle line at 
intervals of one or two inches ; and these lines tend to increase in 
width and length as pregnancy advances. They are known to phy- 
sicians by the Latin name of linim albicantes, and give a very distinct 
impression of skin stretched beyond its elastic power, just as india- 
rubber might be overstretched. When they appear in persons of dark 
complexion, the white color is usually replaced by a brown pigment, 
and they are found as darker colored streaks on the natural skin. 
When once clearly produced, they very seldom disappear entirely in 
afterlife, although alter confinement they become much narrower and 
less distinct. Usually, in a few months after confinement, they become 
entirely white, even in cases where, before confinement, they have been 
deeply colored, and remain as white streaks on the abdomen through- 
out life, affording often a reliable indication of the previous occurrence 
of pregnancy. Similar lines, although very much smaller, occasionally 
occur on the breasts when much distended with milk. As this disten- 
tion only happens with most women after childbirth, the streaks are 
only formed after the confinement has taken place ; but in those cases 
where milk is present in considerable abundance before the birth of 
the child, these lines may be found at a late period of the pregnancy. 
The lines on the breasts, as on the abdomen, are usually permanent in 
afterlife ; but if they are only slight they may disappear without leav- 
ing traces. The formation of these lines on the skin of the abdomen is 
sometimes accompanied by some sense of discomfort and even pain, 
which is described as a sensation of stretching and dragging. 

Their appearance on the abdomen may sometimes be entirely pre- 
vented by wearing continuously a belt such as has been described 
above ; and in cases where the distention of skin is too great to admit 
of prevention, the wearing of the belt will usually diminish their extent 
and size, and will also much alleviate any suffering which they may 
cause. There is some reason to think that the inunction of oil, such as 
olive or linseed oil, increases the elasticity of the skin ; and as they are 
perfectly harmless applications, it is well, on the slightest appearance 
of stretching, to rub into the skin, morning and evening, one of those 
oils. The inunction is also useful in the alleviation of discomfort. 



3 S DISORDERS OF PREGNANCY. 

[Dr. Foote's Magnetic Ointment is an oily preparation -with special 
soothing properties that render it of great service in many ways to the 
parturient woman, and especially during the later stages of pregnancy, 
and for the relief of abdominal and vaginal soreness following labor. 
It is effective in preventing caking and soreness of the breasts, and 
there is nothing equal to it for tender or cracked nipples. See page 
12-28.] 

To the breasts it is more difficult to apply treatment. There is no 
objection to the gentle rubbing with olive-oil ; but any undue pressure 
upon them to prevent enlargement might injure the secretion of milk, 
besides possibly doing harm in other ways. In cases where a loose 
corset can be worn with comfort during the later months of pregnancy, 
the support of the breasts on pads within the corset may assist in prevent- 
ing excessive stretching ; for the stretching is generally more noticeable 
on the upper than on the under surface of the breasts. Pads for the 
purpose can be easily made of cotton-wool covered with linen, and 
stitched inside the upper part of the front of the corset. 

Swelling of Feet and Legs is a not unfrequent source of incon- 
venience in the later months of pregnancy. It is generally due to the 
pressure of the womb, as it increases in size in the abdomen, on the 
veins which convey the blood returning from the legs, the circulation 
being thus impeded. TVhen the swelling is slight and confined to the 
feet and ankles, it is not usually of much importance, nor does it give 
much annoyance. But when considerable, and extending up to or 
beyond the knee, it not only impairs to some extent the walking 
powers, but also produces a sense of heaviness and fatigue. The main 
importance of the existence of swelling in the feet and legs is, that it 
is in some cases an indication of the presence of some congestion of the 
kidneys, which is apt to lead to future harm if not attended to. So 
long as the swelling of the feet and legs is slight, so long as there is 
no swelling of the eyelids or other parts of the face, while the general 
health remains good, and the quantity of urine normal in amount and 
color, the patient need not have any anxiety about the existence of this 
symptom ; but if the swelling is considerable in the legs, and appears 
at all in the face, it is very desirable that she should consult a medical 
man on the matter. 

In the slighter cases, the use of a belt to support the womb often 
relieves the pressure on the veins sufficiently to obviate the swelling of 
the legs ; and if that does not suffice, raising the legs on a chair while 
resting, or lying on a couch for one or two hours daily, will prevent any 
discomfort. Gentle rubbing upwards of the legs for a quarter of an 
hour, once or twice a day, will much assist in reducing swelling. Sim- 
ple slight swelling of the legs should never be an excuse for omitting 
one's usual exercise. 



DISTENDED AND VARICOSE VEINS. 



39 



Distention of the Veins of the Legs sometimes occurs as a 
further result of pressure upon the veins, which conduct the blood from 
the legs. It is met •with in two forms. More generally, there is an in- 
crease in size of all the smaller veins in the skin of some part of the 
leg, so that the course of each small vein can be distinctly seen, and the 
leg is covered with a net-work of reddish-blue blood-vessels. Such 
general increase in size is apt to occur in patches in different parts of 
the leg — the inner and outer sides of the thighs, and the inner side of 
the leg and ankle being frequent sites. The surface of the skin over 
them is smooth, and there are no projecting veins forming swellings on 
the skin. 

In the other form, one or two large veins are enlarged and swollen, 
and form projecting and discolored lines along the legs and thighs. 
The lines are of a deep blue color, and are somewhat tortuous ; one 
may often be traced continuously from the ankle to the top of the 
thigh. "When they are very conspicuous, they are usually more or less 
knotted as well as tortuous ; and are always worst in the inside of the 
leg and thigh, although occasionally found as well on the outside. 

To this second form more particularly the name of varicose veins 

is usually given. The two forms may be, and often are, found together 
in the same person. Those distended and varicose veins are not by 
any means peculiar to pregnancy. The tendency to them is usually 
hereditary, and has probably some relation to the inherited diathesis 
of gout and rheumatism. But this tendency may be dormant until 
excited by some cause, and pregnancy is undoubtedly one of the most 
frequent exciting causes of distended and varicose veins in women. As 
the majority of women escape this discomfort even after repeated 
pregnancies, it is probable that pregnancy of itself, in the absence of 
any hereditary tendency, is not sufficient to cause this condition of 
veins. In many instances, even when the distention is considerable, 
complete recovery follows the confinement, recovery being more fre- 
quent in the first than in the second description. 

When either form appears, its extension can often be prevented by 
attention and care. As in the case of swollen legs, the use of a belt, 
and occasional resting with the feet elevated, will go far to relieve the 
pressure upon the veins. Special attention to the regular action of the 
bowels is also of much importance ; and even where there is a natural 
daily action, it is usually of advantage to take some mild aperient med- 
icine once or twice a week. Regular exercise is also of great use in 
distention of the veins. The muscular action of the ]eg involved in 
walking is markedly beneficial in assisting the circulation of the veins, 
and obviating the tendency to varicosity. On the other hand, standing 
still or sitting with the legs hanging down is prejudicial ; and if the 
distended veins are present in the leg as well as in the thigh, it is 



4Q 



DISORDERS OF PREGNANCY 



always well to rest with the legs supported on a chair or on a sofa. If 
the distended veins are present only in the thigh, there is not the same 
objection to sitting with the legs hanging down ; but standing should 
be avoided. 

When the second form of distention exists — in other words, when 
varicose veins are present, it is desirable to support them by the exter- 
nal pressure of a bandage or an elastic stocking. If a bandage is em- 
ployed, the best material is thin flannel, or domette ; thin calico also 
may be used. At whatever part of the leg the varicose vein may be 
situated, the bandaging must be commenced at the foot and carried 
upwards to a point one or two inches above the upper end of the vari- 
cosed part. The most convenient width for a bandage is three inches, 
and the length will depend upon the height to which the limb is to be 
bandaged. If only to below the knee, a bandage of five yards long 
will be sufficient ; if it is to be carried half-way up the thigh, about 
nine yards will be required ; while if the whole of the thigh as well as 
the leg requires support, a bandage of twelve yards will be necessary. 
Generally, the bandage may be left off at night on going to bed, and 
put on before rising in the morning ; but there is no objection to its 
being worn all night if comfort is derived from its use. 

Elastic stockings must be obtained from a maker, and are usually 
made to measure. They can be had in two materials, silk and cotton ; 
and different qualities of each of these materials are met with. The 
silk are the more expensive, but are more durable and more comforta- 
ble than the cotton ones. The durability, however, is not of so much 
importance when worn during pregnancy, as it will generally be found 
that the stocking worn during pregnancy will be too large to be of use 
after confinement, so that, if required at all afterwards, a smaller one 
must be obtained. [By sending proper measurements, elastic stockings 
can be obtained by mail from the Sanitary Bureau. See page 1227.] 

Elastic stockings are injured by being worn at night ; they should 
therefore be taken off on going to bed, and put on before rising in the 
morning. If any support is required for the veins at night, a bandage 
should be used ; the stocking being removed, and the bandage put in 
its place while lying down. 

Piles or Haemorrhoids are often the cause of considerable dis- 
comfort during pregnancy, appearing at a very early stage, and contin- 
uing more or less throughout the whole course. The predisposition to 
piles is hereditary, and is closely associated with the tendency to vari- 
cose veins in the legs ; in fact, in their commencement, piles are really 
small varicose veins in the neighborhood of the opening of the bowels. 
They appear, however, often during pregnancy in patients who have 
no hereditary predisposition to their occurrence, their appearance being 
due in many cases to constipation. 



PILES OR HEMORRHOIDS. 4I 

Piles are met with in two forms. In the first, which are called 
internal piles, there is nothing to be seen on external examination, 
and their presence is usually indicated by the appearance of a little 
blood after the bowels have been moved. Frequently, also, some 
streaks of blood will be found on the motions. The amount of blood 
lost after the motion of the bowels varies very much in different per- 
sons, seldom probably exceeding one or two tablespoonfuls, and in many 
cases not amounting to more than one teaspoonful. If the motion is at 
all hard, its passage is often followed by pain, lasting for some time, 
generally of a burning character. Frequently, however, no pain is 
experienced, and the presence of blood is the sole indication of the 
existence of piles. Sometimes, when an internal pile is large, or when 
it is situated immediately within the opening of the bowel, it will come 
down into the opening after the bowels have acted, and being squeezed 
in the opening will give rise to much pain, which can usually be 
relieved at once by pressing the pile with the finger upwards into the 
interior of the bowel. [Pelvic Pine Cones (see page 1228) exert a most 
soothing, tonic, and comforting effect on internal piles, going as they do, 
"right to the spot." They contain the soothing properties of Magnetic 
Ointment, and the mild astringency of the pine.] 

External piles appear as small swellings, varying in size from a 
pea to a marble, round the margin of the opening of the bowel, and 
occasionally partly within it. When not inflamed, they are of the color 
of natural skin, or of a bluish tinge similar to that of a vein seen 
through the skin ; they are apt to vary a little from day to day both in 
color and in size. When large, they cause some discomfort in sitting, 
and sometimes also when walking, and are often very painful for some 
time after an action of the bowel. External piles do not bleed. Occa- 
sionally they become inflamed, and are then acutely painful. When 
attacked by inflammation, they may increase in size so much as to attain 
the dimensions of a hen's egg. Their color becomes changed to a 
dusky red, and the reddened skin becomes so tense as to appear partly 
translucent ; not infrequently it gives way here and there, and small 
superficial ulcers covered with a little matter appear on the surface. It 
is very seldom, however, that the inflammation progresses so far as to 
form an abscess ; after a few days rest and care it usually subsides. 

The occurrence of piles may be often prevented by proper attention 
to regularity in the action of the bowels, by due support of the abdo- 
men, and by warm clothing. When they do occur, either internally or 
externally, the same precautions will, in the majority of cases, obviate 
much of the discomfort to which they sometimes give rise. When in- 
ternal piles bleed much and often, it is very desirable to obtain medical 
assistance, as a daily loss of even a small quantity of blood is quite 

sufficient to impair considerably the general health. 
2a 



42 DISOKDERS OF PREGNANCY. 

If an internal pile descend after the bowels have been moved, and 
remain painfully grasped by the opening of the bowel, it should be 
carefully pressed upwards with the finger, coated with a little vaseline 
or sweet oil, until it recedes completely within the opening. [Nothing 
does so well for this purpose as the Magnetic Ointment, which not only 
helps to relieve at once, but also exerts a curative influence when 
applied daily — or as often as required to return the prolapsed pile. 
See page 1228.] 

External piles are often much reduced in size, and rendered less 
sensitive, by sponging them with cold water morning and evening. In 
some cases sponging with water as hot as it can be borne gives 
greater relief. Standing much on the feet is apt to increase their size ; 
and the recumbent posture for an hour or two daily will often do much 
to render external piles innocuous. When they become inflamed, rest 
in a recumbent position is absolutely necessary ; and great comfort is 
derived from frequent warm fomentations, and from the application of 
linseed poultices. "When piles are inflamed, it is generally desirable to 
abstain entirely from all alcoholic fluids. Much attention should be 
given to the regular daily action of the bowels ; and if necessary some 
licorice powder should be taken every night, or sulphur lozenges every 
morning, [or one or two Anti-bilious Pills.] 

Vaginal Discharge and Irritation. — During pregnancy there is 
not unfrequently more or less discharge from the vagina, sometimes of 
a watery character, at other times of a more thick and creamy appear- 
ance. It seldom exists to such an extent as to render it necessary to 
wear a diaper ; but not unfrequently the discharge is rather irritating, 
and causes itching and some degree of soreness externally. This itch- 
ing and soreness are usually much alleviated by bathing the parts once 
or twice a day with warm water alone, or with warm water in which 
some bicarbonate of soda, or some borate of soda has been dissolved. 
A convenient strength of lotion is made by dissolving a full teaspoonf nl 
of either of these salts in a pint of warm water. If such a lotion is not 
sufficient to allay the itching, the application of some carbolizcl vase- 
line two or three times daily may be tried. When the discharge is 
excessive in quantity, or very irritating in character, it may be neces- 
sary to syringe the interior of the vagina once or twice daily with warm 
water, or with such a lotion as is given above. For this purpose a 
family syringe, such as has been described on page 33, for administer- 
ing enemas, is employed, the longer terminal tube being placed over 
the proper end. This gum-elastic tube being covered with vaseline, 
after the syringe has been charged with the warm water or lotion, and 
the weighted end left immersed in it, is introduced gently into the 
vagina for two or three inches, and the lotion injected by successive 
gentle compressions of the ball of the syringe. The lotion, after com- 



SLEEPLESSNESS. 



43 



ing in contact with the interior of the vagina, escapes at the sides of 
the gum-elastic tube. 

AVomen who can bear cold bathing well will often find that a cold 
bath, and where possible a sea-water bath, taken regularly every morn- 
ing, is very efficacious in curing both the excessive discharge and the 
consequent irritation. It may be remarked here that to those who in 
ordinary health enjoy sea-bathing, there is no risk from open-air bath 
ing during pregnancy ; and often the influence of sea-bathing under 
these circumstances is distinctly beneficial to the general health. 

Sleeplessness is occasionally the source of considerable discom- 
fort in both the earlier and the later months of pregnancy. In the 
earlier stages, it is usually due more directly to discomforts of digestion 
or to attacks of palpitation ; while, later, the disturbing movements of 
the child, aud difficulties of position owing to increase of size, interfere 
occasionally with sound slumber. Any treatment must be directed to 
the cause upon which the sleeplessness is dependent. Care in diet, and 
regulation of the action of the bowels, will assist much in sleeplessness 
due to indigestion. 

"When the movements of the child are troublesome, the wearing of 
a belt or binder at night, as well as during the day, will often render 
them more tolerable, and apparently sometimes even less violent. The 
binder is also useful where the enlargement of the figure makes the 
attainment of a comfortable position difficult ; and some assistance 
toward this can also be obtained by the disposal of small cushions or 
pillows in such a way as to give support where it may be required. 

Narcotic drugs for producing sleep should never be taken except 
under medical advice. In many ways they may do injury, not only to 
the mother, but also to the infant, and their use is justifiable only 
under conditions laid down by a qualified doctor. 



CHAPTER V. 

Miscarriage, its Causes. Bisks, Prevention, and Management. 

Definition of Miscarriage; Usual Periods of Occurrence: Earlier Miscarriages; 
Difficulty of Eecognition; Necessity of Care after their Occurrence; Cause 
of Miscarriage: Indications of Threatened Miscarriage; Discharge of 
Blood: Pain; Preventive Treatment; Best; Coolness; Light Diet; Indica- 
tions for Medical Aid: Necessity of Patience: Symptoms of Inevitable Mis- 
carriage; Description of Abortion; Indications of Complete Bemoval: Be- 
sults of Incomplete Bemoval; Convalescence from Miscarriage: Necessity 
of Best; Value of Syringing: Preparation of Lotions; Diet during Conva- 
lescence: Occasional Discomfort of Breasts: Final Bemarks. 

The term miscarriage or abortion is usually applied to the pre- 
mature birth of the infant at any time during the first six months of 
pregnancy. After the first six months, if confinement takes place 
before the usual period of nine months has elapsed, it is generally 
called premature confinement. Although miscarriage may occur at any 
period "within six months after the commencement of pregnancy, it 
most commonly takes place either about one month after the time of 
conception, or between two and a half and four months after that date, 

The earlier miscarriages, after about one month's pregnancy, are 
not generally regarded as of much importance, and in many cases their 
character is not recognized, the accompanying discharge of blood being 
mistaken for an ordinary monthly period, postponed a little in date and 
slightly increased in amount. Very frequently it happens in married 
women that the usual monthly period is one or two weeks late, and is 
accompanied by some amount of pain, and more or less increased flow 
of blood ; and it will often be noticed that in such a case the flow lasts 
somewhat longer than usual, and may be followed for some days or 
even longer by a colorless or yellow discharge. The explanation of 
these exceptional conditions is usually the occurrence of an early mis- 
carriage ; and while in most instances no ill effects are left behind, it 
is not very- uncommon to find some uterine discomfort, in the form 
perhaps of continuous slight discharge from the vagina or aching of 
the back after much exertion, owing its origin to a miscarriage of the 
kind described. If any of the symptoms of pregnancy have been ob- 
served prior to the postponed discharge, little doubt can exist as to its 

nature ; and, w T hen such indication exists, it is always judicious to try 

44 



CAUSES OF MISCARRIAGE. 



45 



to avert any evil consequences by resting quietly for two or three days, 
avoiding all fatigue and exposure to cold, and spending at least part of 
the day recumbent on a couch. It should always be borne in mind that 
miscarriage at any period, early or late, of pregnancy, is an abnormal 
process which necessarity involves some degree of injury to the womb ; 
and it is a fact well recognized by the medical profession that to 
neglected miscarriages are attributable a great number of the more 
common diseases of the womb so frequently met with in practice. 

Pig. 6 




FIKTUS OP THREE TO FOUR WEEKS— NATURAL SIZE- 
MEMBRANES IN THE WOMB. 



-AS CONTAINED IN ITS 



The importance, therefore, of care and circumspection during such an 
occurrence ought to be fully recognized by every married woman. 

Causes of fliscarriage. — For the early miscarriages just de- 
scribed, it is not easy to point to any cause beyond mentioning the gen- 
eral fact that throughout pregnancy there seems always to be some 
slight tendency to miscarriage at such dates as would correspond to 
the monthly periods, which are usually suppressed during pregnancy ; 
and this tendency is probably stronger about the time of the first 
monthly interval after pregnancy has commenced. 

The causes of later miscarriages may be found in circumstances 
connected either with the mother or with the child. There seems no 
doubt that some women have an innate tendency to miscarry, even 



4 6 MISCARRIAGE OR ABORTION. 

when apparently in perfect health, the explanation probably lying in 
some irritability of the nervous system. There is also a tendency to a 
repetition of miscarriages at about the same period of pregnancy, even 
in cases where the first miscarriage may have been due to accidental 
causes. 

Any illness which has enfeebled temporarily or permanently the 
constitution will predispose to miscarriage ; and menial anxiety and 
icorry probably act in a similar manner. Acute diseases accompanied 
by fever have a very adverse effect on pregnancy, and high fever from 
any cause always endangers its continuance. 

Fig. 7. 




A *IX WEEKS OLD FCRTUS IX IT? SAC, WITH THE MEMBRANE* BY WHICH IT IS 
ATTACHED TO THE WOMB. 

Imprudent conduct, such as over- fatigue in walking, or riding, or 
dancing, has a tendency to induce miscarriage, and there is especial 
risk in exercise involving sudden shocks, such as jumping on horseback. 
Sudden mental s7iocks, especially those of a startling or alarming char- 
acter, account for a considerable number of miscarriages. The most 
important cause of all referable to the mother is probably the existence 
of slight disease of the iromb, or of tissues in the neighborhood of the 
womb. Some diseases of this organ in their slighter forms produce 
comparatively little discomfort, and partly from this reason, and partly 
from motives of delicacy, are not unfrequently entirely neglected ; and 
the penalty of the neglect is incurred in the form of successive miscar- 
riages, which in their turn eventually aggravate the previously existing 
disease to which they are to ho attributed, [When the "abortion 



SYMPTOMS OF MISCARRIAGE. 



47 



habit " has become established as a state of disease, or when the womb 
has become too tender and "touchy" to carry on the process of child- 
bearing to "full term" — as it often does, because of chronic disease — it 
is fortunately generally possible to restore the parts to normal condition 
by suitable local and constitutional treatment. The "abortion habit" 
is risky and exhausting, and should be overcome for the sake of the 
woman's health, if for nothing else. See page 1226.] 

Miscarriages, again, are not unfrequently due to some disease 
affecting the infant in the womb. There is no doubt that from the very 

Fig. 8. 




EMBRYO OR FffiTUS OF BIGHT WEEKS IN ITS SAC, AND ATTACHMENTS; ALL OF 
WHICH COME AWAT IN A MISCARRIAGE. 

beginning of pregnancy, the infant itself is liable to disease, indepen- 
dently altogether of the state of health of 1 lie mother. These diseases 
frequently terminate in the death of the child within the womb, and 
miscarriage usually ensues very soon afterwards. 

Indications of Threatening Miscarriage. — In most cases of 
threatened miscarriage, the first symptom which attracts attention is 
the discharge of blood from the vagina. Very frequently, prior to this 
occurrence, some indefinite sensation of discomfort may have been ex- 
perienced. Sometimes the commencement is indicated by sensations of 
cold, and even shivering, followed by slight fever ; in other cases, sen- 
sations of weight at the bottom of the abdomen, a feeling of cold there, 
mn} perhaps slight occasional attacks of pain low down in tho back or 



43. 



MISCARRIAGE OR ABORTION. 



abdomen, may have awakened suspicions of possible risk. Occasion- 
ally, a considerable amount of pain in the lower part of the abdomen is 
felt before any discharge is observed. The pain is usually of a very 

Fig. 9. 




FCETUS AT FOUR MONTHS, EXPOSED IN ITS MEMBRANES, SHOWING CORD. 

characteristic description, resembling somewhat that of colic, and being 
regularly intermittent, the intermissions, as a rule, lasting longer than 
the paroxysms of pain. The regularity and the situation of the recur- 
rent spasms generally are sufficient to distinguish them from those 
due to colic of the bowel. Even in those exceptional instances where 
pain is the earliest prominent symptom, the discharge of blood soon 
follows ; and the combination of the two indicate conclusively the im- 
minent risk of miscarriage. 



PREVENTION OF MISCARRIAGE. 49 

The amount of discharge varies very much in different cases, and 
at different, stages. At first it is generally slight, and may resemble 
very much that of an ordinary monthly period ; but it generally 
increases to a degree much beyond this if the miscarriage progresses. 

After the discharge has existed for some variable time, an amount 
of pain is usually felt in the lower part of the abdomen, beginning in 
slight rhythmical spasms at intervals of some minutes, and becoming 
gradually more severe, with shorter intervals between the spasms. As 
the pain increases, the amount of discharge usually increases also, and 
in a few cases becomes so much as to excite considerable alarm. 

Preventive Treatment. — Since it is almost always impossible to 
know whether the threatened miscarriage is due to the death of the 
infant in the womb, or to some condition relating to the mother which 
may be remedied, it is judicious and right always to presume that the 
infant is alive, until distinct evidence of its death is obtained, and 
accordingly to take what measures are calculated to prevent the prog- 
ress of the miscarriage, and insure the safe progress of the pregnancy ; 
and it is encouraging that in many cases, even where the discharge has 
been considerable and the pain troublesome, judicious means are suc- 
cessful in arresting the unhealthy action of the womb, and saving the 
life of the threatened infant. 

With this end in view, it is the imperative duty of every woman 
who has the prospect of becoming a mother, when the first symptoms 
of threatened miscarriage appear, to remain completely at rest in the 
recumbent position. If there is no symptom except the colored dis- 
charge, and if this is not excessive in amount, judged comparatively 
with the usual monthly period, it may not be considered necessary to 
summon medical assistance ; but the maintenance of rest in a horizontal 
position is of essential importance. The atmosphere of the room should 
not be too warm, and excessive warmth of clothing or bed-clothes 
should be avoided. Diet should be light and easy of digestion, prefer- 
ence being given to milk-food and fish ; and the food taken should not 
be very warm, as heat of any kind is apt to increase the amount of dis- 
charge, and the consequent risk of miscarriage. There is no objection 
to thickened soups or to tea, if taken when slightly cooled. When 
miscarriage is threatened, purgative medicines which are at all likely 
to act violently should be carefully avoided. It is not, however, well 
to allow the bowels to become too confined ; and when necessary, a 
little castor-oil or licorice powder may be taken, or the bowels may be 
acted on by an injection of glycerine. 

If the discharge becomes excessive in amount, or if pain to any 
great extent supervenes, it is very desirable that medical assistance 
should be obtained as earl}'- as possible. 



5 o MISCARRIAGE OR ABORTION. 

To most women the management of their health when a miscar- 
riage is threatening will be found rather a trial of patience. Not per- 
haps always realizing the importance of the matter, and the necessity 
of what may appear severity of restriction, the maintenance of rest and 
the restraint of diet to many are apt to appear unnecessarily irksome. 
A comparatively slight discharge, unaccompanied by pain, will occa- 
sionally persist for some weeks ; and it will generally be found to 
increase when movement is made, or when the erect position is assumed. 
To a woman accustomed during her ordinary .monthly period to lead 
her usual life, this may seem a very poor reason indeed for giving up 
entirely her ordinary avocations, and adopting for a time the r61e of an 
invalid. But the importance of the object sought will be more fully 
recognized when one realizes that a human life is at stake — a young 
life, it is true, but one which, if preserved by a few weeks' care and 
self-sacrifice on the part of the mother, may attain to many years of 
future usefulness. There are very few conditions in which the full 
confidence of a patient in her medical attendant is more demanded than 
when she is under treatment for threatened miscarriage. Patients, as 
a rule, are very desirous that their medical attendant should at least 
"do something ; " while in many cases of the kind under description, 
much the best method of conducting the pregnancy to a satisfactory con- 
clusion is to do nothing, beyond exercising a careful and judicious obser- 
vation. True it is that medical science is in possession of drugs which 
serve to allay pain when severe, and to restrain excessive uterine action ; 
but in a considerable number of cases the employment of such drugs is 
not required. The symptom which most usually calls for medical 
treatment is the existence of excessive discharge. When rest, coolness, 
and abstinence have been insufficient to keep the discharge within such 
limits as will not seriously impair the strength of the patient, there are 
other resources within the means of a medical man, which can always 
be relied on to arrest the bleeding. These means, however, rather tend 
to provoke than to restrain the tendency to miscarriage, and are there- 
fore not generally employed until the necessity of arresting the dis- 
charge becomes quite apparent. 

If the means described above are not sufficient to arrest the prog- 
ress of the miscarriage, it will be found that the intermittent parox- 
ysms of pain continue with greater frequency and severity, while the 
discharge will persist. As a rule, the discharge is not characterized by 
any odor ; and if in the absence of any local treatment to arrest the 
bleeding a distinctly disagreeable or fetid smell is perceived, a fairly 
reliable indication is given that the infant is dead, and that therefore 
further efforts to prevent miscarriage are superfluous. The object 
thereafter aimed at is to conduct the miscarriage to its termination with 
as little delay as possible, But here also may often be found the value 



PREVENTION OF MISCARRIAGE. 



51 



of the advice of the Latin motto, Festina lente — " Speed gently." One 
of the difficulties connected with miscarriage is the tendency of the 
womb at this stage to expel part of its contents and retain another 
part, instead of ejecting the whole at one time. At about the end of 
the third month of pregnancy the contents of the womb may be thus 
described. The interior cavity of the womb at this period varies from 
about the size of a cricket-ball to that of a croquet-ball or cocoanut. 
This is almost completely occupied by a membranous bag filled with a 
watery fluid, in which floats the young infant, at this, period from four 
to five inches in length. From the navel of the infant a thin cord pro- 
ceeds to one point in the interior of the bag, and this cord is the only 
connection between the infant and the mother, excepting, of course, 
the watery fluid with which it is surrounded. Coming from the navel 
of the child, it passes through the bag, and is spread out in a sort of 
cushion attached to the inside of the womb, which is known as the 
"placenta." The bag of membranes and the placenta together entirely 
fill the cavity of the womb. The placenta is fleshy in appearance, 
round or oval in shape, and about half an inch to an inch thick in the 
centre, becoming thinner at the edges. One side of it is closely attached 
to the outside of the bag of membranes, the other is adherent to the 
internal wall of the womb. 

During the progress of a miscarriage which has become inevitable, 
the bag of membranes usually bursts, and the contained watery fluid 
escapes along with the discharge of blood. In many cases the enclosed 
infant comes away soon afterwards, and is found outside the vagina, 
attached only by the cord to the placenta, which is still adherent to the 
womb. The cord varies very much in length, and in many cases is 
quite long enough to allow the child to escape entirely from the vagina, 
while still attached to the placenta ; but if it is not long enough for 
this, it usually breaks, and the attachment to the placenta is thus lost. 

In those cases where the infant is expelled before the placenta has 
become separated from the wall of the womb, it not unfrequently hap 
pens that the womb ceases for a time its effort to expel the whole of its 
contents, and, closing up to some extent after the expulsion of the 
infant, encloses within its cavity the adherent placenta and attached 
membranes. The enclosed placenta then begins to decompose, and 
keeps up a fetid discharge, accompanied sometimes by considerable 
bleeding, which is not only very disagreeable and annoying, but also 
injurious to the general health. 

In guiding a miscarriage to a satisfactory couclusion, the main 
object of the medical man is to secure, as far as possible, that the cav- 
ity of the womb shall be entirely emptied of all its contents, including 
the infant, the placenta, and the membranous walls of the bag. It is 
found generally that the most satisfactory method of accomplishing 



52 MISCARRIAGE OR ABORTION. 

this is to abstain as far as possible from hurrying the process of miscar- 
riage. For a satisfactory termination to a miscarriage, two conditions 
at least are necessary : one that the mouth or entrance of the womb at 
the upper end of the vagina should be sufficiently open to allow the 
infant and placenta to come out ; the other, that the connection be- 
tween the placenta and the interior wall of the womb should be severed 
completely, or at least to a considerable extent, before the infant is 
expelled. Both these conditions are effected slowly by the successive 
contractions of the womb, which are the cause of the rhythmical parox- 
ysms of pain ; and if the process of miscarriage is too rapid or hurried, 
difficulties are very apt to arise from the continued adherence of the 
placenta to the womb. As the cause of the bleeding during a miscar- 
riage is the separation of the placenta from the wall of the womb, it 
will be easily understood how the retention of the placenta is usually 
accompanied by bleeding as well as by fetid discharge. When the 
placenta is thus retained, medical aid and observation are urgently 
required ; and no patient can be considered convalescent until it has 
come away by itself or been removed by the skill of the doctor. 

"When a miscarriage is of the normal character, no one will have 
difficulty in recognizing the separate contents of the womb, which have 
been described above — the infant or foetus, as it is usually called, the 
placenta, and the membranes. It happens, however, not unfrequently 
that the appearance of the contents is modified in various ways. Some- 
times the bag of membranes bursts on the first appearance of bleeding, 
and the blood may be poured into the bag of membranes, displacing 
the watery fluid. When this occurs, the infant is destroyed by the sur- 
rounding blood ; and the membranes enclosing the blood, along with 
the placenta external to them, may come away with the appearance of 
a large clot of blood. Occasionally the placenta is attacked by disease, 
and as the infant depends for its nutrition through the cord on a 
healthy condition of the placenta, the disease of the placenta is fol 
lowed by the death of the infant, and the resulting miscarriage has a 
quite abnormal appearance. And, again, in cases where the infant has 
died from some disease, miscarriage may not take place at once, and 
the placenta and dead infant become much altered in appearance dur- 
ing their retention in the womb. 

In consideration of these facts, it is always very desirable that any 
solid body coming from the womb should be kept for the inspection of 
the medical attendant. Anything of the kind is best kept for inspec- 
tion in a little water ; and if it is disagreeably fetid some colorless dis- 
infectant, such as carbolic acid, may be added ; but no disinfectant 
which will alter its color or appearance should be employed. [The 
illustrations given in the first part of this chapter will aid almost any- 
one to discover, by careful inspection, whether a foetus has come away.] 






CONVALESCENCE FROM MISCARRIAGE. 



53 



In general, the medical attendant will be able to satisfy himself by 
inspection of the miscarriage and by other means of the completeness 
of the removal ; but in some cases it is quite impossible to be absolutely 
sure that no small fragment of placenta has been left behind. 

The complete evacuation of the womb is usually followed immediately 
K)j complete cessation of the pain which, in most cases, has been expe- 
rienced during the progress of the miscarriage. Sometimes slight 
pains occur at intervals for twenty-four or thirty-six hours after the 
completion of the miscarriage. This is not, however, common ; and 
when such attacks of pain do occur, their intensity is slight, and their 
subsidence rapid. The continuance of pain for more than forty-eight 
hours after the apparent removal of the miscarriage would indicate the 
necessity of medical examination, and the probability of retention of 
some of the contents of the womb. 

The discharge also diminishes rapidly after the contents of the womb 
have been completely removed. Not unfrequently, the arrest of the 
discharge is almost immediate and complete ; but more generally it sub 
sides gradually, being of a red color for two or three days, and 
changing gradually from red to green, then becoming yellowish, and 
finally ceasing. While the discharge is disappearing, it is not unusual 
to observe it occasionally becoming rather more red-colored and profuse 
after any undue exertion or excitement ; and if this alteration is only 
temporary, lasting perhaps for a few hours or a day, it is not of much 
importance, except in so far as it indicates the desirability of continued 
care and rest. If, however, it becomes again of a very bright red color, 
and is excessive in quantity, or continues of this character for more 
than one or two days, it is probably indicative of incomplete evacua- 
tion, and calls for medical attention. 

Convalescence from niscarriage. — During convalescence noth- 
ing is so important as, rest in the recumbent position, maintained for at 
least one week. It has been remarked previously that one of the most 
fertile causes of minor diseases of the womb is neglected miscarriage. 
After such an occurrence, the womb is left bruised, sometimes slightly 
lacerated, its inner surface raw and sensitive, and its whole weight 
increased ; and the womb itself, and also the tissues in its neighbor- 
hood, are very prone at such a time to be affected with inflammation, 
which is sometimes of rather intractable character. While it is incor- 
rect to say that inflammatory consequences are always due to impru- 
dence, there is no doubt that in many cases they can be distinctly 
attributed to some want of care ; and they are always aggravated, even 
when not caused, by injudicious laxity after miscarriage. 

The duration of the rest required varies considerably with the 
character of the miscarriage, and the duration of the pregnancy, as 
well as with the general state of health of the mother. In most cases 



54 MISCARRIAGE OR ABORTION. 

of miscarriage at about the end of the third month of pregnancy, the 
patient may be allowed to sit up in bed to meals after three or four 
days have elapsed ; and may change from bed to a sofa at the end of a 
week. Persistent aching of the back on sitting up is an indication that 
caution must be exercised ; and it is always much better to remain 
recumbent for a few days longer than to risk the straining of the uter- 
ine ligaments, of which the backache is often a symptom.. 

When the discharge has entirely disappeared, and the sitting post- 
ure can be maintained for one or two hours without fatigue or aching, 
some amount of walking may be permitted ; and the normal manner of 
living is gradual!}* resumed. 

During the convalescence, great comfort is often experienced from 
syringing the vagina twice daily with warm water, to which some anti- 
septic fluid may be added. The discharge is not unfrequently fetid in 
odor, and sometimes rather irritating in character, and the syringing 
removes the fetor and reduces the irritating quality of the discharge. 
An ordinary family syringe may be used for the purpose, with the 
larger vaginal pipe slipped into the delivery end ; and for an antiseptic, 
carbolic acid may be employed. A convenient antiseptic lotion is made 
by adding one tablespoonful of the last mentioned, to a pint of warm 
water. [The ••tablespoonful" of carbolic acid (for a pint of water) 
should be the "one to forty" solution sold by druggists, or the diluted 
watery solution, and not the pure acid. A soapy solution made with 
No. 33 of the Sanitary Bureau soap, affords a handy and efficient means 
of vaginal cleansing. See page 1230.] 

Diet during Convalescence. — While a somewhat restricted diet 
has been indicated as appropriate during any threatening of miscar- 
riage, after its completion a more liberal regimen is desirable and 
proper. Soups, fresh fish, fowl, game, and mutton, with vegetables, 
may be taken, and there is now no objection to the food being warm. 
Indigestible articles of diet, such as cured fish, richly seasoned dishes, 
and pkstry, should be avoided. 

Fulness of the Breasts. — In a limited number of cases of mis- 
carriage, some degree of fulness of the breasts, with sensations of ten- 
sion and tenderness, is experienced ; and there may be a slight flow of 
milk from the nipples. If this occurs, it is judicious to limit the diet 
for a day or two, and to refrain from stimulants. The local discom- 
fort of the breasts will be relieved by gentle rubbing with olive-oil [or 
better, Magnetic Ointment] and an occasional mild aperient of com- 
pound licorice powder, or some effervescing saline, will assist in 
reducing the breasts to their normal condition. 

Cautions. — In view of the proneness to inflammatory uterine 
affections after miscarriage, it is important that symptoms pointing to 
disease of the womb should not be treated with neglect, even although 



FINAL CAUTIONS AS TO MISCARRIAGE. 



55 



they may not be very troublesome. Aching of the back after exertion, 
the occasional or constant presence of vaginal discharge, whether 
white, yellow, or watery in character, exceptional pain, or excessive 
discharge during the menstrual periods, are symptoms which would 
suggest the propriety of medical advice and treatment. [These condi- 
tions of local congestion and even inflammation can be properly attended 
to at home by the aid of advice and remedies furnished according 
to the methods made known on pages 1224, 1225, and 1226. To neglect 
them is to invite prolonged suffering from local weakness, with a 
chance of establishing the abortion habit, and this of course means 
barrenness, which may be incurable, if neglected.] 

In the event of a succeeding pregnancy, it is well to bear in mind 
the tendency mentioned at the commencement of the chapter to mis- 
carry at the period of gestation at which in the previous pregnancy 
abortion occurred, and at that time to be specially careful and prudent, 
so as to obviate as far as possible the risk of a similar disaster. 



CHAPTER VI. 

Prematuke Confinement. 

Definition; Causes; Recognition of Cause ; Cause of Premature Confinement; 
Importance of Prevention; Effects of Premature Birth on Child and on 
Mother; Necessity of Care in Later Months of Pregnancy; Signs of Im- 
pending Confinement; Recurring Attacks of Pain; Distinction from Colic; 
Precautions Necessary ; Baby Incubators. 

Premature Confinement is the term generally employed to char- 
acterize child-birth occurring after six months of pregnancy have 
elapsed, and before the full period of nine months' gestation has been 
attained. It is generally presumed that after pregnancy has progressed 
for six months in a normal manner, the infant is not unlikely to live, 
even when born prematurely ; in technical language, the infant, alter 
six month's gestation, is considered "viable." There is, however, no 
rigid distinction of time of gestation, on one side of which it can be 
strictly affirmed that the infant must be born dead or die shortly after 
birth. Children have undoubtedly lived who have been born as early 
as the end of the fifth month of pregnancy. On the other hand, a con- 
siderable proportion of infants born in the seventh month of preg- 
nancy live only for a few hours, not apparently being strong enough to 
undertake prematurely the burden of a separate existence. The dis- 
tinction between "miscarriage" and "premature confinement," and 
between "non-viability" and "viability " of the infant, is purely a con- 
ventional one ; but it is convenient in the opportunity it affords of 
indicating considerable differences of character in the premature termi- 
nation of pregnancy, according as it occurs in the earlier or the later 
stages of gestation. 

The Causes of Premature Confinement, like those of miscar- 
riage, may be referable either to the mother or to the infant. Weak- 
ened health in the mother may result in the premature birth of the 
infant. The various causes which have been enumerated in the chapter 
on Miscarriage may act similarly in the later stages of pregnancy. 
Some women, for no very apparent reason, seem never able to progress 
beyond the seventh or eighth month of pregnancy, and each succes- 
sive pregnancy is found to terminate prematurely at the same period of 
gestation. Sometimes excessive distention of the womb from excep- 

56 



CAUSES AND COURSE. 57 

tional amount of fluid surrounding the infant seems to induce premature 
confinement ; and twin pregnancies are apt to terminate prematurely, 
probably for the same reason. Accidental discharge of blood in the 
interior of the womb is an occasional cause. 

Relative to the infant, the same remarks apply which were made in 
the chapter on Miscarriage. In the later period of pregnancy, it is 
usually much more easy to specify the cause of premature confinement 
than in the earlier months. The fact that the infant is alive within the 
womb can be ascertained by the presence of movements and confirmed by 
other signs ; and the absence of such indications for more than a few 
days would excite suspicions of its death. It is not judicious, however, 
for a pregnant woman to assume at once from the cessation of move- 
ments that the infant's life is endangered or lost. It is not uncommon 
to be unconscious of movements for some days, probably because the 
movements are less violent than usual, although they may not have 
ceased altogether. Even an educated medical man will often hesitate 
to decide, without repeated examination, that the life of the infant is 
irrevocably lost ; and the only safe rule of conduct is always to assume 
that the infant is alive until very distinct evidence of its death is 
obtained. 

The Course of a Premature Confinement resembles very 
closely that of a confinement at the normal period of nine months' ges- 
tation ; and as it will be described fully in the chapter on Normal 
Confinement, only the earlier indications and the means to be adopted 
to arrest, if possible, the premature termination of the pregnancy will 
be related here. 

It is desirable to realize the importance of using every endeavor to 
prevent Uie premature expulsion of the child, and to prolong the preg- 
nancy to its full term, when there is no sufficient reason for believing 
that the infant has ceased to live. There is always some degree of 
weakness and want of vitality observable in an infant born before the 
completion of nine months of pregnancy. In proportion to the prema- 
turity of its birth, it is small and thin ; its movements are feeble, and 
its cry is weak and moaning, in place of being strong and lusty. Its 
breathing is shallow and feeble, and its power of feeding itself by suc- 
tion somewhat limited. Infants born prematurely are exceedingly 
susceptible to cold ; their hands and feet become livid if at all exposed, 
and they shiver unless carefully protected by very warm clothing or 
cotton-wool wrappings. It is found that they do not progress with the 
same rapidity as infants born at full time. They do not gain weight at 
the same rate as infants more fortunate in their birth, neither do they 
develop in other respects so satisfactorily. They are late in getting 
teeth and in walking ; and their mental faculties occasionally mature 
very slowly. They are also more prone to the disease of rickets, and 



5 8 PREMATURE CONFINEMENT. 

if they have any hereditary tendency to scrofula, it manifests itself 
early, and frequently severely. Very ofcen the whole of their later 
life is characterized by some degree of delicacy, which is often found 
associated with a stature and physical development considerably below 
the average. 

While the infant born prematurely suffers thus on the one hand 
from its own imperfections, it not unfrequently is placed in a disad- 
vantageous position also by the inability of the mother to afford it 
adequate nourishment. The maternal breasts have not attained their 
full maturity, and both the quantity and the quality of the milk 
secreted by them are apt to be defective ; and these defects, super- 
added to the difficulty which the prematurely born infant encounters in 
sucking properly, render the early nutrition of such infants a matter 
calling for care, and not unfrequently exciting anxiety. 

These considerations emphasize the propriety of exercising due 
care, and some degree, perhaps, of self-denial, in the later months of 
pregnancy. Over- fatigue should be especially avoided, while exercise, 
so far as possible, should be taken regularly ; reasonable discretion in 
diet should be exercised, and excesses of all kinds strictly avoided. The 
temptation to tight lacing, in order to conceal alterations of figure, 
must be strenuously resisted, as pressure of any kind is apt to induce 
labor. A reasonable arrangement of loose clothing will generally effect 
this purpose quite satisfactorily, and prevent the alteration of figure 
being conspicuous or noticeable. 

The slightest appearance of any discharge of blood f ram the vagina 
calls imperatively for absolute rest, and indicates the propriety of med- 
ical advice. Unlike the more early miscarriages, premature confine- 
ments very seldom commence with any discharge of blood. The first 
indication that confinement is commencing is generally the presence of 
recurring attacks of pain resembling colic, and usually felt in the abdo- 
men just where the spasms of colic are generally situated. Occasionally 
they are referred more to the back ; but as a rule there is nothing in 
the character of the pain to distinguish it from that produced by colic. 
Some distinction between the two is found in the more regular recur- 
rence of the spasms of pain in labor than in colic. The spasms in colic 
recur at irregular intervals, and successive attacks are often experienced 
at different parts of the abdomen ; while the recurrent pains of labor 
usually come in regular rhythm, and generally are felt in the same part 
of the abdomen. Colic pains are frequently accompanied by some 
diarrhoea, and when that occurs it is of some value in indicating the 
true character of the spasms. The most marked point of distinction 
is found in the fact that, during the spasmodic pain of labor, the whole 
of the womb felt through the abdominal walls is found to become 
firmer and harder ; and the firmness and hardness diminish and 



BABY INCUBATORS. 



59 



disappear as the pain passes off, recurring again when the pain returns. 
This increased firmness and hardness is easily detected by any one 
laying the palms of the hands flatly on the walls of the abdomen 
during the spasm of pain. When recurrent pains of this description 
are experienced by a pregnant woman one or two months before the 
full time of pregnancy has elapsed, she ought to remain at rest on a 
sofa or bed, and send for her medical attendant. If he is able to 
satisfy himself that the infant is living, and that premature confinement 
is threatened, there are various medicine within his knowledge which 
are often effective in removing the pain, and arresting the premature 
action of the womb ; and the present care and self-denial of the mother 

Fig. 10. 




THE FUERST INCUBATOR. 

a, window; b, moist sponges; c, thermometer; d d d, opening in box, above and 
below, for ventilation; e, e, e, e, e, hot soapstones for heating. 

are in due time rewarded by the birth of a strong child at the end of 
the full period of healthy pregnancy. 

[Infants born considerably before "full term" may often be saved 
from what used to be considered "the inevitable." Tn short, during the 
past fifty years, and mainly since 1890, a few original minds among the 
physicians in charge of baby institutions, have seen the necessity of sup- 
plying sufficient and constant warmth for such infants, and a variety of 
baby incubators have been contrived. Some very elaborate and auto- 
matic baby hatchers have been supplied for the use of large institutions 
where premature birth is not uncommon, so that the mortality of 
infants born a month or two too soon has been greatly reduced (from 
66 to 36 per cent.). Even "six months babes " are not despaired of, and 
if bora alive are given the best possible opportunity to survive by the 



60 PREMATURE CONFINEMENT. 

favorable conditions of palatial infant incubators of richly endowed 
foundling asylums. These elaborate contrivances are very expensive, 
and the call for them is so infrequent that they cannot be put on the 
list of household necessities, but when the rather rare event of prema- 
ture birth of a living child occurs where a ready-made ''conveuse" 
(the French name) cannot be obtained, a life may be saved by knowing 
how to make a baby-hatcher out of an ordinary box, as proposed by Dr. 
L. Fuerst, of Leipzig, in 1887. The illustration on page 59 shows its 
construction so well that his lengthy verbal description is hardly neces- 
sary. About a dozen heated soapstones are needed to raise the interior 
temperature to the required 90 degrees, and these can be exchanged or 
renewed as necessary. If such a chest is not made too tight the air 
will be changed by entering at the bottom and gradually passing out at 
the top, while the wet sponges impart moisture. These too early birds 
need warm air to breathe, as well as protection from loss of their own 
body heat, and many a puny infant born at the right time might be 
greatly aided in its growth and development by the use of such means to 
insure artificial warmth while it is too feeble to make body warmth for 
itself. When, for various reasons, mothers are unable to give their 
babies the close personal attention they need, such hatching boxes 
might be a great boon, especially in cold weather, and give them a 
boost along the first path of a life which many of them find a hard 
road to travel all through.— E. B. F., Jr.] 



CHAPTER VII. 



Preparations for Confinement. 

Selection of Doctor and Nurse; Arrangements Regarding Fees; Advantages 
of Personal Interview with Monthly Nurse ; Selection of Room; Drainage 
of House; Accommodation of Nurse ; Furniture of Room ; Bed-Pan; Bed- 
Bath; The Family Syringe ; Douche; Sponges; Sanitary Towels; Binders; 
Antiseptic Fluids; Carbolized Vaseline; Baby's Bath; Soap; Baby's Dia- 
pers; Bassinette; Baby's Basket; Its Contents; Waterproof Sheeting; 
Arrangement of Bed; Attention to Regular Action of Bowels. 

When the existence of pregnancy has become apparent, and the 
probable date of its termination estimated within reasonable limits, it is 
desirable to make certain arrangements so that the process of confine- 
ment may be passed through in safety and comfort, and that the result 
may be satisfactory as regards both the complete recovery of the 
mother and the well-being of the infant. To this end it is usual to 
engage beforehand the services of a medical attendant and of a monthly 
nurse. Not unfrequently in early married life attendance during con- 
finement will be the first service the wife requires of a doctor ; and, if 
her new home is far removed from the old, she will be called upon to 
exercise a choice as regards her medical attendant. To some extent the 
selection may be limited by local conditions, or by her capacity to meet 
the different scales of fees charged by different medical men. She will 
find her various friends not backward in describing the merits and de- 
merits of their own medical advisers, and may find considerable difficulty 
in coming to a decision amidst a multitude of councillors. The best 
principle to go upon is to select the medical man in whom she feels she 
can place most confidence. The relations between patient and doctor 
are close and frequently confidential, and the man whom she can trust 
as honest and straightforward is the one whose attendance she will find 
most satisfactory. For the ordinary troubles of life one does not 
require a medical man of preternatural cleverness, whereas one does 
want a doctor who can be relied on to do his very utmost for his patient, 
and who can be trusted to act always in an honest and honorable man- 
ner in the various and sometimes intricate relations in which he may 
be placed toward his patient and her friends. Personal predilection 

will decide whether the doctor should be young, or old, or middle- 

f.1 



62 PREPARATIONS FOR CONFINEMENT. 

aged ; but it may be remarked that it is a mistake to suppose that all 
young medical men are rash and thoughtless, or that all old ones are 
stupid and "behind the age." Having provisionally selected a medical 
man, patients who are not in such a position as to be independent of 
pecuniary considerations ought to ascertain from him his scale of fees. 
Medical fees vary very much in different localities, and among different 
doctors ; and it is very much better to understand correctly at the 
commencement of the relationship of doctor and patient the terms upon 
which it is to be conducted. The doctor tacitly covenants to give the 
best consideration and skill in his power to further the welfare and 
interests of his patient, in consideration of the patient paying him with 
reasonable punctuality the fees which he is accustomed to receive for 
such services ; and the patient by sending for him virtually agrees to 
pay such fees. It is, therefore, perfectly just and reasonable that she 
should know beforehand what the usual fees of her medical attendant 
are ; and she should have no hesitation in asking the question. If the 
doctor's scale of fees is higher than she can afford, it is wise and judi- 
cious to say so, thus giving the doctor the option of lowering his fees, 
or of declining to attend. Medical practices vary so much in character 
that it is impossible to give any very definite information in the matter 
of fees. The majority of general practitioners of medicine have what 
are called mixed practices, which means that their patients vary 
greatly in social position, and that the scale of their fees is proportioned 
to the financial condition of the patient. A considerable number of 
doctors, however, have what are known as select practices, and decline 
to attend any patient who is not in a position to pay the fees which 
they make their minimum charge. Fair-minded people will recognize 
that a medical man has just the same right to select his patients as the 
patient has to select a doctor, and will not feel aggrieved if the condi- 
tions under which a doctor is willing to give his services are not quite 
compatible with their own financial resources. Having selected a med- 
ical man, and ascertained his usual scale of fees, it is well to consult 
him about the date at which confinement may be anticipated and to 
ask him for any advice he may wish to give as to any preparations for 
that event. 

The Nurse. — It will generally be found desirable to take the 
recommendation of the doctor as to a monthly nurse. The comfort of 
the patient during the period occupied in recovery from confinement 
will be materially increased by harmonious interaction between the 
doctor and nurse ; and medical men naturally recommend nurses whom 
they know to be both efficient in their duties and pleasant and accom- 
modating in their manners. It is undoubtedly to the doctor's as well 
as to the patient's interest that the nurse should be both able and trust- 
worthy, and hi<? capacity and opportunity of judging of a nurse's quali- 



CHOICE OF BEDROOM. 63 

fications are naturally greater than those of the patients who may have 
previously employed her. Good monthly nurses usually expect to be 
engaged some months previous to the probable date of confinement ; 
such nurses, when popular, not unfrequently have engagements for six 
or seven months in advance. It is customary to arrange with them a 
fee which covers attendance during four weeks from the date of 
confinement ; and a reasonable degree of elasticity as regards the date 
is always understood as necessarily involved in such an arrangement. 
The fees of monthly nurses vary quite as much as those of medical 
men, and should be made a subject of distinct arrangement. Generally, 
it is understood that the monthly nurse will not be summoned until the 
commencement of the confinement ; but many women may prefer to 
have their monthly nurse in their house for a week or two before the 
date of expected confinement, so that she may be on the spot when 
required. When an arrangement of this kind is made, the nurse usually 
receives some fee for the time she is waiting in the house previous to 
the confinement, this fee being at a somewhat lower rate usually than 
the fee for the month following the confinement. Sometimes the patient 
may prefer that the nurse should remain with her more than four 
weeks, and then also it is usual for the scale of payment to the monthly 
nurse to be somewhat lower after the expiry of the four w r eeks 
following confinement. All such arrangements should be definitely 
made, when possible, at a personal interview with the nurse on engag- 
ing her ; and where a personal interview is impossible or inconvenient, 
a distinct understanding should be arrived at by letter. 

In all cases, when possible, the expectant mother should have an 
early interview with the nurse who is to attend her and care for her 
during her confinement. The nurse can assist her much in suggestions 
by which the period may be passed in comfort and happiness ; and, as 
every nurse has her own special methods of work and her own partic- 
ular requirements and conveniences, the relation between patient and 
nurse will be more harmonious if some little attention is given to these 
peculiarities. Like medical men and other people in this world, nurses 
vary in age, ability, and temperament. Not so many years ago, it was 
an article of faith that no woman was capable of acting as a monthly 
nurse unless she was at least verging upon old age, and had herself 
been the mother of children. Matters are now quite changed in this 
respect, and many of the best monthly nurses are quite young, and 
frequently unmarried. 

Choice of Bedroom. — When the accommodation of the house 
affords a choice of bedrooms to be occupied during confinement, it is 
desirable to select the largest available room ; and one which enjoys 
much sunshine is preferable to one with a northerly aspect, The room 
is to be occupied for the greater part of a month by at least three per- 



64 PREPARATIONS FOR CONFINEMENT. 

sons — the mother, the infant, and the nurse ; and it is conducive both 
to the recovery of the mother and the health of the child that the room 
should be both well ventilated and purified by sunshine. If the con- 
finement is to take place in summer, dark blinds may be desirable for 
the purpose of coolness and of shade during the hottest and brightest 
part of the day. External sun-blinds are very useful for this purpose, 
and are valuable also in assisting in ventilation while controlling 
draughts. 

The cleaning and sweeping of a room is always a trying operation 
to an invalid confined to bed, and arrangements should be made to 
obviate these proceedings as far as possible. Polished wooden floors, 
-with mats or strips of carpet which can be easily removed and dusted, 
are much preferable in bedrooms to floors entirely covered with carpet ; 
and their convenience is especially noticeable in cases where the bed- 
room is occupied all day as well as at night. In winter, the heating of 
a bedroom occupied during the day should be by an open grate. Gas 
fires, which are very convenient for occasional use, are ineligible in a 
room constantly occupied, as they injure somewhat the atmosphere of 
the room, and do not aid ventilation so efficiently as an open fire. 

It is exceedingly important that the drainage of a house in which 
any one is to be confined should be in a thoroughly satisfactory condi- 
tion ; and in all cases where there is any doubt about the efficacy of 
the sanitary arrangements, a competent surveyor should be employed 
to report on it. In many districts the services of such a surveyor can 
be obtained gratuitously from the Local Sanitary Authority ; and 
where the Sanitary Authority does not provide an inspector, a compe- 
tent surveyor can usually be obtained to report for a comparatively 
small fee. Xo money can be better spent, for a sanitary condition of 
the Louse is decidedly the most important element in insuring a satis- 
factory and unimpeded recovery from confinement, while an insanitary 
condition is often the cause of months of illness after confinement. 

For the accommodation of the nurse, it is very convenient, where 
possible, to have a small room either opening off or adjacent to the bed- 
room of the mother. The nurse has various duties to perform to the 
mother and child which are most conveniently carried out in a room 
apart from the bedroom ; and by the use of a small room for these pur- 
poses is able to maintain the bedroom always in a tidy and neat condi- 
tion. Such a room can also be utilized by the nurse for her meals, 
when they are taken apart from her patient. 

The bedroom in which confinement is to take place should not be 
inconveniently filled with furniture. Furniture occupies space which 
otherwise is occupied by air useful for ventilating purposes ; and it is 
impossible to be too careful in the thorough ventilation of the lying-in 
chamber. Among the essential articles of furniture may be mentioned 




REQUISITES FOR THE MOTHER. 65 

a double bed with mattresses which, are not too soft ; a comfortable 
night-stool or chair for use during convalescence, and a convenient 
toilet-table with drawers to hold necessary articles. Some of the arti- 
cles to be mentioned are requisite for the comfort and convenience of 
the mother, while others are devoted to the use of the nurse, or the 
wants of the infant. 

Requisites for the Mother.— Of the articles desirable for the 
mother one of the most important is a comfortable bed-pan. For some 
days after confinement, the patient is not usually allowed to leave bed 
for any purpose, and the use of a bed-pan becomes necessary. Bed- 
pans are made of stoneware or metal, and are of various shapes. The 
most convenient kind is the slipper shape (Fig. 11) made in white stone- 
ware, or a modification of this known as the Anatomical Bed-pan. For 
comfort in use, it is usual to make 

for the bed-pan one or two remova- Flo# 11# 

ble flannel covers, which can be 
taken off and washed when neces- 
sary. 

Another appliance very desirable 
and useful is an invalid bed-bath, an 
illustration of which is shown on 
page 66 (Fig. 12). Its use obviates bed-plan supper. 

the fatigue which often follows the 

attention of the nurse to perfect cleanliness, and enables her to perform 
her duties thoroughly without any risk of rendering the bed damp or 
uncomfortable. The best bed-baths are made of japanned tin, and are 
filled at the lower end with a waste-pipe and tap attached to an india- 
rubber tube, the other end of which is carried to a receptacle on the 
floor. By leaving the tap of the waste-pipe open, any quantity of water 
can be used for washing or douching without any risk of the bed-bath 
overflowing, the overflow being carried away by the waste-pipe into 
the larger vessel on the floor. 

In addition to ordinary washing after confinement, most doctors at 
the present time insist upon daily douching of the vagina by the nurse 
with some antiseptic fluid ; and for this purpose either & family syringe, 
such as is described at page 33, or a fountain syringe of the kind pict- 
ured in Fig. 13, page 66, is necessary. The latter is the more convenient 
of the two for the purpose indicated. It consists of a rubber vessel, of 
capacity sufficient to hold at least a quart, to the lower end of which is 
attached a flexible india-rubber tube of about six feet in length, termi- 
nating in a gum-elastic perforated nozzle, such as is used with the 
family syringe, with a stop-cock about six inches from the end. A nail 
or hook upon which it can be hung when in use should be fastened to 
the wall, about three feet above the left side of the head of the bed. 



66 



PREPARATIONS FOR CONFINEMENT. 



The advantage the douche possesses over the syringe is, that when the 
vessel has been filled with water or antiseptic lotion and suspended on 
the hook, the fluid runs through the tube, and, when the stop-cock is 
opened, out of the nozzle, without any action on the part of the nurse, 
who has thus both her hands free for other purposes ; while in the use 



Fig. 12. 




BED-BATH. 



Fig. 13. 




of the syringe one hand is occupied with propelling the fluid by pres- 
sure, and only one hand is left available for other services. 

One or two sponges are necessary for use in the ablution of the 
mother and the baby. The same sponge should not be used for both ; 
and when ordinary sponges are employed, great 
care must be taken that they are absolutely 
clean. A satisfactory method of insuring their 
freedom from possibly contaminating germs is to 
leave them lying in a solution of carbolic acid, 
composed of one part of carbolic acid to twenty 
parts of water, for twenty-four hours, after they 
have been thoroughly washed out in warm 
water. Much preferable to ordinary sponges for 
the mother are the artificial sponges now made 
of absorbent cotton-wool enclosed in antiseptic 
gauze. Each sponge of this kind is only to be used once and then 
destroyed ; but as their cost is very little, their use is not expensive, and 
all risk of septic poisoning from a dirty sponge is avoided. 

For the absorption of the discharge which comes from the vagina 
for some time after confinement, most women use ordinary diapers ; 
and if these are thoroughly clean, and of soft material, they answer the 
purpose very well. More comfortable and convenient are the sanitary 
towels, or absorbent wool diapers, made on the same principle as the 
artificial sponges described above. These, like the sponges, are now 
sold by the dozen at a very low price, and their use not only adds to the 
safety and comfort of the patient, but also obviates the necessity of 
much washing of diapers. 



FAMILY SYRINGE. 



REQUISITES FOR THE INFANT. 67 

1 

After confinement, it is usual for the mother to be bound round 
the abdomen for two or three weeks with a broad binder, which affords 
support to the abdominal muscles weakened by the distention of the 
previous months of pregnancy. The two qualities required in a binder 
are firmness and softness. The best material for them is somewhat 
stiff toweling ; and they should be made long enough to just meet 
round the abdomen before confinement, so that the ends may overlap 
after confinement, and broad enough to extend from below the hip to 
an inch or two above the lowest rib. Belts fitted with buckles, to be 
used in place of the ordinary binder, are sold by surgical instrument 
makers ; but these have no advantages over the binder as just described. 
The binder, when adjusted after confinement, is secured by strong 
safety pins, a supply of^ which should be kept beside the binder. Three 
or four binders are necessary, as they may become soiled and require 
to be washed. 

The use of Antiseptic fluids for bathing and douching after con- 
finement is now almost universal. Medical men differ in their prefer- 
ence for particular antiseptics, and it is well for the expectant mother 
to ask her medical attendant which antiseptic he recommends. The 
most commonly used is carbolic acid, diluted to the extent of one part 
of the fluid to forty parts of water. [Soap No. 33, offered by Dr. Foote s 
Sanitary Bureau, is an excellent antiseptic soap for use in preparing 
a vaginal douche, or for cleansing the outer parts before and after 
confinement. See page 1230.] 

A feeding-cup, a small pot of carbolized vaseline, some scent, and 
ordinary toilet requisites will complete our list so far as the wants of 
the mother are concerned. 

Requisites for the Infant. — For the expected baby some, prepar- 
ation also falls to be made. For convenience in washing the baby, it is 
not uncommon to have a special baby's bath, about the size of an ordi- 
nary foot-bath, but much more shallow, which is fitted into a stand 
about a foot high, from which it can be removed to be emptied and 
cleaned. Such a bath is not absolutely necessary, as an ordinary foot- 
bath, or even a large basin, is sufficient for the purpose ; but its posses- 
sion conduces to the comfort of the nurse, and avoids the risk of any 
injury to the baby, such as may happen from contact with the sides 
when a foot-bath is employed. 

Any kind of good soap may be employed for washing the baby. 
[Dr. Westland names some English soaps which are not obtainable in 
this country. Soap No. 31, offered in the list of the Sanitary Bureau, 
on page 1230, is one of the good ones.] 

For drying the baby after it has been washed, the softest Turkish 
towels should be used ; and after thorough drying, the baby is pow- 
dered with some soft powder, such as Fuller's earth, starch powder, or 



68 PREPARATIONS FOR CONFINEMENT. 

so-called violet powder. [A very pleasantly scented and soft powder 
useful for this purpose is offered as No. 37, of the Sanitary Bureau 
list of toilet articles described on page 1230.] 

It is unnecessary here to enter into the question of the baby's cloth- 
ing ; something will be said later on the matter ; but the importance of 
eoftness and dryness in the diapers for the use of the baby require that 
mention should be made of the best material for their construction. 
This is undoubtedly soft Turkish toweling. This material is soft, ab- 
sorbent, easily washed, and retains its softness even after frequent 
washing ; and is much to be preferred in every way to linen, cotton, or 
calico. Lately, diapers of absorbent cotton-wool have been introduced 
for the use of babies, but they are ineligible on account of their exces- 
sive warmth. India-rubber waterproof sheeting should never be used as 
an outside covering to diapers. Its use simply affords an excuse for the 
nurse not changing the diapers as often as necessary, and interferes 
with the healthy action of the child's skin, not unfrequently setting up 
acute irritation of the legs and lower part of the abdomen. 

It is convenient to have the bassinette or cradle, which is prepared 
for the baby, of such a size and shape as to be easily portable. "When 
the mother has so far recovered as to be able to move from one room to 
another, it is convenient to have both baby and bassinette in the room 
to which she may have removed ; and a heavy and cumbrous bassinette 
is difficult and awkward to carry. Babies undoubtedly rest with more 
comfort in a small than in a large bassinette, as it is more easy in a 
small one to give them the support they desire, and to maintain their 
warmth. When a baby is lying down, it is often uncomfortable unless 
supported on either side by small pillows or blankets ; and when the 
bassinette is too wide it is difficult to give this support. Rocking-cradles 
are scarcely ever employed now ; and the propriety of swinging or 
rocking babies to sleep is questionable, probably interfering to some 
extent with healthy digestion. There is no objection to the use of cur- 
tains to a bassinette, except in so far as they diminish its portability : 
and besides adding to its appearance, they are useful in screening 
light and preventing draughts. It is usual to place the various articles 
required for the baby's toilet in an open basket, so that they be imme- 
diately available when wanted. The contents of the basket will include 
needles and thread, scissors, safety and other pins, some tape, a skein 
of strong cotton thread, flannel and other rollers, some flannel for 
washing baby, a little old linen, a small hair-brush, a powder-box with 
small puff [a box of Sanitary Powder, No. 37. a cake of soap, Xo. 31. 
and a pot of Magnetic Ointment]. 

Preparation of the Bed. — For the purpose of protecting the bed 
from being soiled during confinement, some waterproof sheeting is desir- 
able. It is best to have two pieces of sheeting — one large enough K 



PREPARATION OF THE BED. 69 

cover almost the whole of the bed, measuring about six feet by five 
feet ; the other not quite so large, about four feet by three feet. At 
the commencement of the confinement the bed is arranged in the fol- 
lowing manner. The large waterproof sheet is spread above the mat- 
tress, and covered with a blanket, over which the under sheet is placed. 
Upon this the smaller waterproof sheet is laid in such a way that one 
end hangs a little over the left side of the bed, while the other end 
extends rather beyond the middle line, the sides of the sheet being 
equidistant from the top and bottom of the bed. This smaller sheet is 
then covered with a folded blanket, and over this is laid a sheet folded 
lengthways, so as to be about three feet wide. One end of this "draw- 
sheet," as it is called, hangs over the left side of the bed, covering the 
waterproof sheet ; the other end is rolled up so as to lie in the middle 
line of the bed, near the farther end of the waterproof sheet beneath it. 
The object gained by this arrangement is that both the bed and the 
patient can be kept thoroughly dry. The larger waterproof sheet 
protects the bed completely from any risk of becoming damp ; and the 
draw-sheet over the smaller waterproof sheet can be pulled through 
gradually from right to left, so that, when the left side becomes soiled, 
it may be folded, and the unused part rolled up in the middle of the 
bed brought into use. When the confinement is completed, the draw- 
sheet, with the folded blanket underneath and the smaller waterproof 
sheet, can be removed without any trouble or fatigue to the mother, 
and a perfectly comfortable and dry bed is presented at once. Draw- 
sheets made of absorbent cotton-wool enclosed in antiseptic gauze have 
lately been introduced, and are both economical and comfortable. 
After use they are destroyed by burning. 

Precaution. — As the time of confinement approaches, it is very 
important for the expectant mother to give attention to the regular and 
daily action of the bowels. This may be secured by the use of com- 
pound licorice powder, or of any other of the aperients mentioned 
previously. It is not necessary or desirable to take the rather nauseous 
popular medicine, castor-oil, habitually toward the end of gestation ; 
but in first confinements, when the process of parturition has actually 
commenced, a small tablespoonful of castor-oil may be taken with 
advantage, and is useful both in promoting the progress of the confine- 
ment, and in diminishing the severity of the pains. 



CHAPTER VIII. 



Confinement. 

Definition; Indications of Commencement; Painful Contractions of Womb; 
Frequency; Distinction from "False Pains "; the Show; Demeanor dur- 
ing First Stage ; Propriety of Laxative Medicine; Food; Transition from 
" First Stage " to "Second Stage "; Description of Contents of Womb, and 
of Action during Labor; Bursting of the Waters; Second Stage; Differing 
Character of Pains; Position of Mother; Termination of Second Stage; 
Position of Child; Management in Absence of Skilled Assistance; Third 
Stage; General Remarks. 

The term confinement apparently was originally employed to repre- 
sent the whole period during which a mother was withdrawn from her 
usual occupations by the act of giving birth to a child ; but it is now 
used in the more limited sense as a synonym for the actual process of 
parturition. This process is generally reckoned as commencing at the 
time that the first painful contractions of the womb are experienced, 
and as finishing when the fleshy body known as the "after-birth" has 
come away with its attached membranes, which generally immediately 
follows the birth of the child. As a matter of fact, however, the pro- 
cess of parturition often commences considerably before any painful 
contractions or, as they are generally called, "uterine pains" are felt. 
The initial contractions of the womb at the commencement of confine- 
ment, are not unfrequently painless, more especially in women who 
have already had one or two children ; and even in first confinements 
the early efforts of the womb to expel its contents may be accompanied 
with so little discomfort that quiet sleep is not interfered with. 

The painful contractions of the womb, which first indicate to the 
expectant mother the near approach of the termination of her preg- 
nancy, resemble very closely the spasms of ordinary colic. They are 
of short duration, lasting usually from a quarter to half a minute ; 
and the intervals between them often extend to half an hour, or even 
to an hour. Sometimes they are felt in the back, but more commonly 
in the front of the abdomen ; and each painful contraction generally 
returns in the same part of the abdomen as the previous one, a distinc- 
tion being afforded in this respect from the pains of colic, which are 

apt to be felt at different points in t he interior of the abdomen. 

70 



FALSE AND TRUE LABOR PAINS. 



71 



True uterine contractions have also to be distinguished from what 
are known as false pains, which occasionally give some annoyance for 
one or two weeks before confinement occurs. These "false pains " are 
actually contractions of a spasmodic character of a small part of the 
womb, of a character analogous to the cramp which affects sometimes 
so painfully the muscles of the calf of the leg. Just as in cramp of the 
leg, the part of the muscle contracted is too small to produce any 
movement of the feet, so the irregular spasmodic action of the part of 
the womb contracted by a false pain is too small to produce any effect 
with reference to the birth of the child ; and the contraction is thus a 
useless and a "false " one. There are three tests available to the invalid 
to enable her to distinguish true uterine contractions from colic and 
from "false pains." 

1. The first is the coincidence with the pain of the general hard- 
ening and increase of firmness of the womb felt through the walls of 
the abdomen, as described in the previous chapter (page 47). This can 
generally be made out distinctly when the invalid lies on her back dur- 
ing the occurrence of the pain. 

2. The second test is the appearance of a discharge from the 
vagina tinged with blood, which is known as a "show." With some 
women this appears early, with others late, and with others not at all ; 
but when it does appear it is positive evidence of the actual commence- 
ment of the process of parturition. 

3. The third test is found in the effect of a moderate dose of cas- 
tor-oil. The pains of colic are generally alleviated, and false pains 
usually cease altogether for some time after the action of the oil ; 
whereas the true uterine contractions of parturition are generally aided 
and increased by its operation. 

Additional probability to the true contractile character of the pains 
is given by the regularity of the intervals between them, by the gradual 
shortening of these intervals, and by the progressive increase in the 
intensity and duration of the pain. In a first confinement, these uterine 
contractions may progress for many hours without being sufficiently 
severe to prevent the patient from moving about the house ; and as a 
rule she will feel more comfortable, and the confinement will progress 
more satisfactorily, if she continues walking about a room or sitting in 
a chair, rather than lying in bed. If the bowels have not been acted 
on freely within six hours before the commencement of the pains, it is 
most desirable that action should be obtained at this stage of the con- 
finement, either by a dose of castor-oil, or preferably by the aid of a 
large enema of warm water. Nothing conduces more to increase the 
rapidity, as well as to diminish the discomfort of confinement, than a 
thoroughly empty condition of the lower bowel ; and this is best 
effected by a large enema of warm water given slowly. 



72 



CONFINEMENT. 



Food may be taken as usual during the progress of this stage of 
confinement ; but no stimulants of any kind should be taken from the 
commencement unless by the direct order of the medical attendant. 
Not unfrequently the inclination for food is diminished by the presence 
of sickness, and when that is present it is best to take only simple 
fluids [such as simple gruel, Zoolak, Kumyss] or milk with soda- 
water. Sickness, although unpleasant, is not at all injurious in the 
early period of confinement ; indeed, in man} 7 cases it facilitates the 
progress of the parturition by relaxing resisting tissues ; and for- 
merly it was not unusual to administer emetics such as ipecacuanha 
and antimony for this purpose. 

After a period of time varying very much with different women, 
and in different confinements, the pains are generally observed to 
change somewhat in character, and from being spasmodic and griping 
they become forcing and down-bearing. This change is coincident 
with progress from what medical men call the first stage to the second 
stage of parturition. Just before confinement commences, the womb 
exists in the form of a large oval bag, with a very narrow and small 
neck at its lower end. The interior of this bag is lined with what are 
known as the "membranes," and these enclose the watery fluid in 
which the infant floats. The sole connection of the infant with the 
mother, independently of the fluid surrounding it, is the umbilical cord, 
which proceeds from the navel of the infant to some part of the wall 
of the womb, where it is attached to the after-birth or placenta, as it is 
called. The 'placenta is a flattened and fleshy cake lying between the 
membranes and the interior of the womb at some part of its inner sur- 
face, and at this period of gestation is so loosely attached to the womb 
as to separate easily from it after the infant is born. During the first 
stage of labor, the womb, by its successive contractions, is forcing part 
of the membranous bag with its enclosed fluid into, and partly through, 
the small and narrow neck of the womb, and the neck is thus dilated to 
admit of the subsequent passage of the infant. This stage is said to be 
completed when the neck and mouth of the womb have been dilated to 
their full extent so as to afford a continuous passage with the vagina 
for the birth of the child. At the end of the first stage usually, but 
sometimes earlier, sometimes later, the membranes generally tear, and 
the greater part of the enclosed fluid is discharged from the vagina. 
This discharge is generally described by nurses as the. bursting of the 
waters, and is often, although not quite accurately, regarded as an indi- 
cation of the commencement of the "second stage." It is always an 
indication that some progress in labor has been made ; but it is not at 
all uncommon for the membranes to tear some time before the neck of 
the womb has been fully dilated, and thus some time before the "first 
stage "has been technically completed. The amount of fluid which 



THE SECOND STAGE. 



73 



escapes varies extremely, depending both upon the amount actually 
contained in the womb, and upon the proportion which is allowed to 
escape under differing conditions of the neck of the womb, and of the 
position of the child within the womb. In a few exceptional cases it 
may amount to some gallons, flooding the bed, and even the floor of the 
room; in the majority, of cases, one or two pints maybe discharged 
either at once, or at short intervals of time. If the "bursting of the 
waters " does not occur till toward the end of the first stage, the 
patient will probably be in bed ; and the uncertainty about the amount 

Fig. 14. 




PLACENTA AND UMBILICAL CORD. 



affords a strong reason for thorough protection of the bed by water- 
proof sheeting. 

When the second stage has been reached, the contractile pains are 
usually of a distinctly more forcing and down-bearing character. They 
recur usually with great regularity, the length of interval between 
them varying much in different confinements. As a rule, the intervals 
are from three to ten minutes, generally becoming rather shorter as the 
confinement approaches its termination. During this stage, which may 
last for several hours, more especially in first confinements, but which 
is occasionally passed through in a few minutes, the patient will gener- 
ally be most comfortable lying in bed ; and as she herself is not aware 

of the rapidity of progress, it is unsafe to get up without the doctor'* 
2a 



74 CONFINEMENT. 

permission, as the birth of the child may take place suddenly, and 
injury may follow if the mother is out of bed. 

The second stage of labor terminates with the birth of the child. 
Most usually, the head of the child emerges first, and is followed by 
the body and leg? ; but In - the feet come first, or the breech 

of the child ; and in these instances the head comes last. When first 
born, the infant still remaiDS attached to the mother by the cord which 
proceeds from the navel of the child to its attachment to the after- 
birth adhering to the interior wall of the womb. Immediately the child 
is born, the doctor or nurse sees that its breathing is not impeded in 
any way by its mouth being covered with blankets, or immersed in any 
discharge ; and proceeds to separate it from the mother by tying the 
cord with thread in two places about an inch apart, and two or three 
inches distant from the child, and cutting it through with scissors 
between the two threads. 

In cases where a child has been born hurriedly, and neither nurse 
nor doctor is present to afford assistance, the mother should lie quite 
quietly with the infant in front of her, simply taking care that its 
breathing is not impeded in any way. Xo injury whatever results to 
the child from remaining attached to the mother by the umbilical cord 
for some time after birth : and if it is allowed to breathe freely and is 
kept warm, it may remain in perfect safety until assistance arrives. 

What is known as the third stage of labor consists of the expulsion 
from the womb and vagina of the placenta, or after-birth, and the 
attached membranes which previously lined the interior of the womb. 
After the birth of the child, the womb contracts very much in size : 
and this contraction loosens the attachment of the after-birth to the 
interior wall of the womb. A few intermittent contractile pains follow, 
and after a short period, varying usually from five to twenty minutes, 
the after-birth is pushed out. carrying with it the membranes, and the 
labor is thus completed. 

The contractile pains which expel the after-birth are generally of a 
very mild character, and not irksome to the mother ; and after the 
expulsion has been effected, there is generally complete freedom from 
pain, and a delightful sense of comfortable rest. Occasionally, there 
is some delay in the expulsion of the after-birth, and some little st- 
ance may have to be given by the doctor in attendance ; but that is not 
a matter which will materially affect the patient's comfort. 

The expulsion of the after-birth is generally accompanied by some 
discharge of blood, which, however, usually ceases almost immediately ; 
to be followed soon by the discharge which continues for the first two 
or three weeks of convalescence. To receive this a sanitary towel or 
diaper is usually adjusted immediately after the confinement is com- 
pleted : and when the draw-sheet and upper waterproof sheet have 



PAINLESS PARTURITION. 



75 



been removed, a binder is pinned carefully round the abdomen of the 
patient, and she is at liberty to rest and sleep. If the discharge is 
excessive in quantity, it is convenient to replace the draw-sheet, but 
this is not usually necessary. 

It is desirable and convenient to point out here that parturition is 
a perfectly natural process, for which the mother has been under- 
going preparation during the whole of the previous pregnancy. Vari- 
ous alterations have been taking place during that period both in the 
joints of the pelvis and in the tissues of related parts, so as to admit of 
the passage of the child when the period of gestation has been com 
pleted ; and these temporary changes in the majority of cases fulfil 
their object so satisfactorily, that the duty of the medical man is lim- 
ited to ministering to the comfort of the mother and guarding the safety 
of the child. The amount of pain experienced by the mother varies 
very much ; in all cases a certain amount of pain has to be borne ; but 
since the introduction by Sir James Y. Simpson of anaesthesia by chlor- 
oform in midwifery, the pain can always be kept within reasonable 
limits ; and where necessary the mother can be made absolutely and 
completely unconscious. The propriety of using chloroform in partic- 
ular cases, and the extent of anesthesia demanded, must always be de- 
cided by the medical man in attendance ; and a judicious patient will 
be guided by his advice. The tendency of the present day is probably 
toward excess in the use of chloroform during confinements, as, natur- 
ally, medical men are always anxious to reduce, as far as possible, the 
pain borne by their patients. 



PART II. 



EARLY MOTHERHOOD. 



CHAPTER IX. 

Convalescence from Confinement. 

Normal Progress after Confinement; Necessity of Quietude; Injurious Effects 
of Excitement: After-pains: Diet after Confinement: Occasional Occur- 
rence of Sickness; Aperients: Discharge; Occasional Excess of Discharge; 
Management: Necessity of Cleanliness; Methods of Douching and Syring- 
ing; Maintenance of Eecumbent Position; Summary of Normal Progress; 
Application of Binder; Alteration of Figure after Confinement; Desquama- 
tion of Skin; Deepening of Color of Hair; Occasional Occurrence of Fever- 
ishness; Necessity of Medical Aid: Susceptibility to Infection during 
Convalescence. 

The Period of Convalescence after Confinement is usually a 
very pleasant one for the young mother. The trials and troubles of 
pregnancy are passed, parturition has been successfully accomplished, 
and a new interest has been added to life in the possession of offspring 
which requires and calls for the loving care and attention of the 
mother. If still some little sacrifice of personal inclinations has to be 
made, and some minor discomforts borne with equanimity, the reward 
in the pleasure of fulfilling maternal duties is more than an equivalent, 
and daily the interest of such duties will be found to increase. 

Usually, after the immediate attentions of the nurse have been ren- 
dered to the mother after childbirth as described in the previous chap- 
ter, a period of complete rest and delicious comfort ensues. Peaceful 
sleep is enjoyed, and for from twelve to twenty-four hours the less the 
patient is disturbed for any purpose, except for the necessary changes 
of diapers when the discharge is considerable, and for the administra- 
tion of nourishment, the better her progress will subsequently be. 
Occasionally, for the first few hours, there is a feeling of excitement 
and nervousness, sometimes accompanied by attacks of shivering ; these 

76 



QUIET; AFTER PAINS; DIET. 77 

discomforts will be found to be allayed completely by quietness and 
subdued light in the room, by warmth of covering, and by the admin- 
istration of light warm food, such as gruel or beef-tea. 

Importance of Quiet. — Even in the absence of any discomfort or 
excitement, complete quietude is most essential for the satisfactory 
progress of the young mother. Slight influences have strong effects 
during the convalescence from confinement, and even the excitement of 
seeing one or two friends is not unfrequently followed by disturbing 
symptoms. A rule upon which many doctors act, and which, although 
perhaps apparently rather stringent, is exceedingly beneficial, is to per- 
mit of no visitors whatever, with the exception of one relative or inti- 
mate friend, once daily, during the whole of the first week after 
confinement. 

Different women naturally differ very much in susceptibility to 
disturbance of this kind, and ill results from excitement are not so apt 
to follow second or later confinements ; but with slight occasional relax- 
ation, the observance of the rule will be found advantageous. 

After=Pains. — After twelve or twenty-four hours have elapsed, 
young mothers are occasionally troubled to some extent with the 
periodic pains which are known as ''after-pains." These are slight 
rhythmical pains occurring at varied intervals, and resembling the 
pains which occur at the commencement of confinement. They are 
caused by spasmodic contractions of the now empty womb. The 
majority of primiparae escape them altogether, but they are generally 
experienced to some extent by mothers who have had two or more 
children. After their commencement, they may continue at intervals 
for two or three days, and are usually complained of most during the 
night. Much can be done to relieve them, and the medical attendant 
will usually administer some medicine which will mitigate their sever- 
ity, when they occur to such an extent as to seriously disturb the rest 
of the patient. The application of flannels wrung out of warm water, 
or of a warm india-rubber bottle to the lower part of the abdomen, 
often adds much to the comfort of the mother when after-pains are 
troublesome. [Women who have resorted to the Magnetic Ointment 
for relief of after-pains state that it is the most prompt and satisfactory 
remedy, and they come to regard it as one of the " indispeusables " for 
themselves in a variety of uses before and after confinement, as well as 
for the baby and its common ailments. See page 1228.] 

Diet after Confinement. — During the first twenty four hours 
after confinement, the mother is usually restricted to a light fluid diet 
consisting generally of bread and milk, gruel, bread and butter, tea, 
soups, and eggs beaten up with milk. Many medical men prefer to con- 
tinue this diet for the first three or four days after parturition ; others 
allow, after the first day, a little solid food in the form of white fish, 



7 S CONVALESCENCE FROM CONFINEMENT. 

poultry, or game. Unless called for by special reasons, stimulants are 
usually interdicted for at least the first three or four days after confine- 
ment ; after that period the question of stimulants falls to be decided 
by habit, temperament, and considerations relative to the nutrition of 
the infant. 

In some mothers some degree of weakness of digestion exists for a 
few days after confinement, and even occasional attacks of sickness 
may be experienced. This is more apt to occur where the confinement 
has been prolonged, or where the mother has been under the influence 
of chloroform for some time during the parturition. In such cases 
considerable care in diet may be necessary for a few days. Milk in 
combination with soda-water is pleasant and useful when nausea is 
present ; when digestion is feeble, and accompanied by flatulence or 
pain, a well-maide soup or chicken-broth will be found both nutritious 
and easy of assimilation. [With some a dry diet of chops and toast is 
preferable at such times.] 

In the absence of any counter-indications, the young mother will 
usually be allowed, after the first three or four days, to return to her 
usual diet ; and any precautions or restrictions which may be imposed 
will be dictated rather with a view to the susceptibility of the nursing- 
infant than to the health of the mother. The digestion of newly born 
infants is very easily deranged, and imprudence in diet in the mother 
will frequently result in great pain to the child, producing disturbed 
sleep and violent fits of crying. Something will be said in the next 
chapter about diet in relation to the quality of milk secreted by the 
breasts. 

Aperients after Confinement.— If the bowels have acted freely 
immediately before confinement, there will not usually be any further 
action for one or two days afterward; and no discomfoit will be 
experienced even if a period of three days elapse before action again 
takes place. If an aperient is then necessary to insure action, it is 
usual to employ either castor-oil, or compound licorice powder, a small 
dose of either being given at night. [Those who have not ready access to 
drug stores where compound licorice powder may be had, can procure 
an excellent preparation of it by mail from Dr. Foote's Sanitary 
Bureau. For address, see page 1228.] 

It is found that under such conditions a smaller dose chan is 
usually required is efficacious ; generally one dessert-spoonful of castor- 
oil or one heaped -up teaspoonful of compound licorice powder will be 
quite sufficient to produce a good action of the bowels in the morning. 
In place of one of these drugs, an enema of warm water, or an injec- 
tion of one or two teaspoonfuls of glycerine may be employed, and 
will generally be considered more pleasant, and be found equally 
effective. The choice between giving a drug or an injection will some- 



DISCHARGE AFTER CONFINEMENT. 79 

times depend on the condition of the breasts as regards tension when 
the secretion of milk is commencing. If the breasts are tense and full 
and uncomfortable, action of the bowels by castor-oil or compound 
licorice powder will be found to relieve them more than by enema or 
injection. 

The amount of the discharge which flows from the womb 
after confinement varies very greatly in different women ; and it is a 
question for the doctor to decide whether in any given case it is exces- 
sive, and should be restrained. "What would be excessive and injurious 
to one mother may be not only normal, but also salutary, to another ; 
and extreme variations, from those requiring one or two diapers daily to 
those requiring twelve or more, are observed without any apparent in- 
jury to health, or interference with convalescence. It is the duty of the 
nurse to watch carefully the character and amount of the discharge, 
and to report at once any abnormality to the doctor in attendance. 
For the first few days the discharge is usually of a character almost 
indistinguishable from blood, although a little more watery than nor- 
mal blood. It has a characteristic, faint, but not unpleasant odor by 
which it can be recognized on a diaper as distinct from ordinary blood. 
After a few days it alters in appearance, becoming rather more watery, 
and changing from a red to a greenish hue ; after which it becomes 
white or watery, and ultimately disappears. Generally, it will have 
disappeared almost entirely by the end of the third week after con- 
finement, but in some cases it may last for four or five weeks. If dis- 
charge of any kind lasts more than five or six weeks after confinement, 
it is an indication that some skilled care is necessary, and the attention 
of the medical attendant should be called to the matter. 

Any appearance of fetor in the discharge should always be reported 
by the nurse to the doctor. A normal discharge after confinement, if 
proper cleanliness is preserved, should never have a fetid or distinctlv 
disagreeable smell. When marked fetor exists, it is an indication of 
possible risk to the mother from septic contamination ; and to obviate 
this risk certain precautions will require to be taken under the direction 
of the medical attendant. Undoubtedly, fetor does exist in a great 
many instances where no evil effects follow, but its existence should 
always be regarded as abnormal, and immediate attention given to im- 
prove the character of the discharge, and prevent any unpleasant 
results. 

A very strong reason for the complete quiet which has been insisted 
upon as necessary during the first week after confinement exists in the 
fact that even slight excitement is found frequently to increase to a 
serious extent the amount of discharge, and sometimes even to bring on 
alarming hemorrhage. This seems especially to result from any sudden 
shock or fright, and great care should be taken by a nurse to avoid, any 



So CONVALESCENCE FROM CONFINEMENT. 

risk of such an occurrence to her patient. "When any alarming increase 
in the discharge is observed, the nurse should reassure the patient, 
lower her head by removing pillows so as to place it on a level with the 
body, and apply cloths wrung out of cold water to the lower part of 
the abdomen — never failing, at the same time, to send a message to the 
medical attendant. 

Even after the discharge has become colorless, a return to its orig- 
inal color may result from excitement or from over-exertion. "When 
this is only temporary, and the quantity not much increased, impor- 
tance is not to be attached to it ; but if the return to a red-colored dis- 
charge continue for more than a day, or if the quantity be much 
increased, the attention of the doctor should be called to its existence. 
It will very frequently be found that when the patient is first allowed 
to sit up in bed to meals, a slight deepening of color is observed in the 
discharge ; no importance need be attached to that occurrence, unless 
it persists on each successive assumption of the sitting-up position. 

Douching. — It has been remarked that when proper cleanliness is 
preserved, the discharge from the vagina normally does not exhibit any 
fetor. It is almost needless to say that when a patient is in charge of 
an educated nurse, there ought never to be any doubt that proper clean- 
liness is preserved. That is the first duty of a nurse. In addition to 
ordinary ablutions, the mother should be bathed, at least twice daily, 
with some antiseptic fluid round the entrance of the vagina ; and [if 
any fetid or malodorous discharge persists] the inside of the vagina 
should be syringed or douched twice a day with a similar fluid. It is 
in discharging this duty that the nurse will find the bed-bath and the 
douche described at page 66 useful and convenient. Any antiseptic 
fluid preferred by the doctor is to be employed. The smooth and 
padded end of the bed-bath is slipped underneath the hips of the 
patient as she lies on her back, and if there is a tube attached to the 
bath for the purpose of emptying it. this is carried to a receptacle 
underneath the bed. The bag of the douche is then almost filled with 
water, at a temperature of about 100 3 F., and whatever antiseptic is 
preferred is added to, and mixed with, the water in measured quantity. 
[Carbolic acid may be employed, as advised on page 67, or one may 

a soapy solution made from soap No. 33 of the Sanitary Bureau 
list of toilet articles, of which a complete list is given on page 1230.] In 
a basin near at hand should be an equal quantity or more of warm water 
rendered similarly antiseptic, with a clean sponge in it, preferably an 
artificial one of absorbent cotton-wool and gauze. The douche-bag hav- 
ing been suspended from the hook fixed on the wall, the nozzle is washed 
in the basin of antiseptic fluid, rubbed over with carbolized vaseline, 
and introduced carefully well into the vagina. The stop-cock is then 
turned, and the fluid from the douche-can irrigates the vagina, and runs 



POSITION AFTER CONFINEMENT. 8l 

out into the bed-bath. After the douching is completed, the entrance 
of the vagina and surrounding parts are sponged with the fluid in the 
basin, and carefully dried with a warm, soft, clean towel, after which 
the bed-bath is removed. 

When a family syringe is employed in place of a douche, it is con- 
venient to use an open hot -water jug to hold the antiseptic fluid. This 
is placed close to the side of the bed on a chair ot low table, and the 
weighted end of the syringe dropped into it. The nozzle of the syringe 
is then washed in antiseptic fluid, lubricated with carbolized vaseline, 
and introduced into the vagina, and is held there with one hand, while 
the dilated part of the syringe is alternately compressed and relaxed by 
the other hand. For the purpose of vaginal douching the longer gum- 
elastic nozzle is employed. 

Position after Confinement. — For at least some days after con- 
finement it is most important that the mother maintain continuously the 
recumbent position, not raising herself to the erect position for any rea- 
son whatever. Any infringement of this rule is very apt to be followed 
by injury to the womb and its surrounding tissues. After confine- 
ment, the womb for some weeks is heavier and larger than in ordinary 
circumstances ; and although the ligaments which support it in posi- 
tion are also strengthened during pregnancy so as to give efficient sup- 
port, after parturition processes go on which impair the relations of the 
womb to its ligaments, and render misplacement and chronic inflam- 
matory troubles the frequent result of imprudence as regards position 
during convalescence. 

For the first few days, at least, the patient must learn to make use 
of the bed-pan during micturition, and when the bowels are acted on. 
The length of time during which the recumbent posture must be main- 
tained varies much according to the strength of the mother, and the 
circumstances in which she is situated. Strong women, leading a life 
in the country with plenty of outdoor exercise, certainly do not require 
to be restricted to the same extent as their more delicate sisters who 
live in large towns. As a rule, however, it may be stated that no one, 
however strong, should be permitted to sit up in bed until at least a 
week has elapsed from confinement, while the majority of women are 
much safer in remaining recumbent for a few days beyond that time. 
There is no doubt that many women, especially in the poorer classes of 
society, assume an erect posture frequently after only two or three 
days from their confinement ; but there is equally little doubt that 
much of the chronic uterine disease so common among these classes is 
due to imprudent conduct in this respect. 

A positive indication that sitting up in bed has been indulged in 
too soon is frequently found in the existence of aching pain .at the 
lower part of the back. If such a pain comes on within some minute- 



82 CONVALESCENCE FROM CONFINEMENT. 

after sitting up, it should be regarded as an indication that the recum- 
bent position should be again adopted for one or two days ; if it comes 
on only after remaining in the sitting position for some time, it should 
be considered a warning signal not to maintain the erect posture for 
more than fifteen to thirty minutes at a time. Another indication of 
risk in this direction is found in the occasional return of red-colored 
discharge, after it has disappeared for a day or two. If the change of 
color is very marked, the increase in quantity considerable, or if the 
alteration persists for more than a few hours, it is wise again to resume 
the lying-down position for one or two days. After sitting up to meals, 
propped with pillows, has been permitted for a few days, without any 
sense of pain or fatigue being experienced, the patient may be lifted 
out of bed to a sofa or couch, and remain there for a few hours daily. 
It is not judicious to try to stand or walk until the sitting posture can 
be maintained for some hours without fatigue ; and care must always 
be exercised to guard against strain in the first attempts to walk after 
confinement. 

Normal Progress after Confinement may, then, be summed ap 
as consisting of one week to ten days' recumbency, one week of sitting 
up in bed for gradually lengthening periods, one week of rest on a 
sofa or couch with occasional gentle efforts in walking ; completed by 
a fourth week of gradual restoration to the ordinary avocations of life. 
This normal progress coincides with the gradual retrogression of the 
enlarged and hypertrophied womb to its usual condition. For the first 
two weeks after confinement the womb can be felt at the lower part of 
the abdomen, at first as large as a small cocoanut, and gradually, day by 
day, lessening in size and prominence ; by the end of the third week it 
has diminished in size so as to become almost imperceptible to ordinary 
palpation, while at the end of the fourth week frequently no indica- 
tion is afforded by the womb, as felt through the walls of the abdomen, 
of any increase whatever in its size. As a matter of fact, the absolute 
resolution of the womb to its original size before pregnancy occupies 
generally six or seven weeks at least ; but that recovery is practically 
perfect in many cases after four weeks is not unf requently indicated by 
the commencement of another pregnancy at that period after confine- 
ment. 

Application of the Binder. — It is usual to continue this to the 
abdomen during the whole four weeks of convalescence. When prop- 
erly applied, it is of value in giving support to the over-distended mus- 
cles, and tends to preserve the figure from undue laxity. It should be 
understood, however, that the function of the binder is to support the 
lax abdominal walls ; and it should never be employed for the purpose 
of compressing the waist. Compression of the waist under such cir- 
cumstances must mean bulging out lower down, and may lead todis- 



THE HAIR AND SKIN CHANGES. 83 

placement of the womb. Rather should the binder be employed for 
the purpose of supporting and lifting upward the lower part of the 
abdomen, so as to remove superincumbent weight from the already 
overweighted womb ; and, with this object in view, it should always 
be drawn more tightly together at its lower than at its upper edge. A 
binder is intended for support, not for compression, and it is only when 
used for this purpose that its employment is beneficial. When the 
mother begins to follow her usual occupations, it may conveniently be 
replaced by a belt, such as has been described as useful in the early 
stage of pregnancy ; and many women will find that the tone of the 
abdominal muscles is improved and the figure regained by wearing such 
a belt for two or three months after confinement. 

Mothers must make up their minds to tolerate the fact that their 
waists will probably measure some few inches more on recovery from 
confinement than they did before the days of pregnancy. The true dis- 
tinction between the figure of the matron and that of the maiden is 
found in the fuller bust and wider waist, resulting as a consequence of 
childbirth ; and when the two are found together, they form a harmo- 
nious combination, natural and artistic. It is sad that so many women 
are blind to this fact, and produce an incongruous result by compressing 
the waist, and causing bulging of the lower part of the abdomen. 

The Hair and Skin. — In the later months of pregnancy it will 
generally be noticed that the hair becomes somewhat more coarse in 
quality, while at the same time the skin tends to become a little rough- 
ened. During the first few weeks after confinement women usually 
desquamate to some extent, and at the same time lose some of the hair 
of the head, which is replaced by hair of a finer texture, but generally 
of rather darker color. 

The desquamation of the skin may be so slight and gradual as to 
escape notice, unless attention is specially directed to it ; but some- 
times it is quite obvious, the surface of the skin coming off in distinct 
small scales, such as are noticed after measles and some other febrile 
diseases. At the same time, there is a tendency to lose any teeth which 
may not be quite healthy ; and occasionally even teeth apparently quite 
healthy loosen and fall out after parturition. In view of the possibility 
of this, it is judicious for expectant mothers to have their teeth exam- 
ined by a dentist in the early months of pregnancy, so that any incip- 
ient disease may be arrested, and the teeth prepared to resist as far as 
possible any prejudicial influence. 

The deepening of color of the hair after confinement is somewhat in- 
explicable ; but the same phenomenon is observed usually when the 
hair has been temporarily lost from any other cause, and the growth 
subsequently renewed. The color darkens more and more with each 
successive confinement. 



84 CONVALESCENCE FROM CONFINEMENT. 

Drawbacks to Rapid Convalescence.— While convalescent** 
after confinement usually progresses in the satisfactory and pleasant 
manner already described, there are occasional drawbacks. 

Reference has been already made to the occasional occurrence of 
marked fetor in the vaginal discharge. When this exists, and some- 
times even before its presence becomes apparent, the mother sometimes 
is attacked with feverishness, manifesting itself generally first by sen- 
sations of cold, accompanied or followed occasionally by distinct shiv- 
ering and chattering of the teeth ; and afterwards by a sense of dry 
heat and discomfort following the sensations of cold. There may be 
distinct headache, and a general sense of uneasiness usually exists along 
with the sensation of increased heat. The initiative shivering of fever 
is to be distinguished from the nervous shivering described above as 
occasionally following parturition, by its late appearance, perhaps two 
or three days after confinement, by the distinct sensation of cold expe- 
rienced, by the presence of headache, and by the succeeding feverish- 
ness. Its occurrence should always be considered a reason for sending 
at once for the medical attendant, as early treatment is most important. 

Susceptibility to Infection. — During convalescence from confine- 
ment women are particularly susceptible to the infection of various con- 
tagious diseases, such as measles, scarlet fever, small-pox, etc. ; and great 
care should always be taken that any possible source of infection, direct 
or indirect, is carefully excluded from the house. It is not sufficiently 
recognized that infection can very easily be conveyed in letters ; and it 
is judicious to arrange that all letters addressed to women convalescing 
from confinement should be opened and read by some one else before 
being given to the convalescent patient. It is a serious shock to a 
medical attendant to be told by his patient that she has just received a 
letter from a female friend apologizing for her inability to visit her, in 
consequence of being detained at home nursing her children in scarlet 
fever or measles. And such experiences are not unfrequent. 

Helps to Convalescence. — In conclusion it may be added that 
the best safeguards for insuring satisfactory convalescence are cleanli- 
ness, fresh air, and as much sunshine as can be obtained. The two first 
are at the command of every one. There is no greater risk of taking 
cold after confinement than at any other time, and the more and the 
further windows can be opened to admit external air, the more satis- 
factory will be the progress of the invalid. Temperature of course will 
have to be regulated ; and when the external air is too cold to admit of 
continuously open windows, a good fire in a bedroom is an admirable 
aid to ventilation ; but even in cold weather it is wise, for a few min- 
utes at a time, twice or thrice a day to have the window of the bed- 
room opened widely, care being taken that the mother and baby are at 
the time properly covered with blankets. 



CHAPTER X. 



The Mother in Relation to the Infant. 

Duty of Mother to Suckle Infant; Occasional Exceptions; Normal Secretion 
of Milk; Importance of Commencing Suckling soon after Confinement; Pro- 
cess of Sucking; Flatness of Nipple ; Management; Breast-Pump; Employ- 
ment of Older Baby: Soreness of Nipple; Fissures of Nipple; Fulness of 
Breasts; Insufficient Flow of Milk; Methods of Increasing Flow; Frequency 
of Suckling; Indications of Discomfort of Baby; Probable Meaning; Ten- 
dency to Painful Digestion; Susceptibility of Infant to Improper Diet and 
Drugs taken by Mother; Tension of Breasts; Localized Hardness and 
Swelling; Abscess of Breast; Relation to Fissures; Importance of Cleanli- 
ness; Objects of Treatment; Question of giving up Nursing; Normal Duia- 
tion of Nursing; Indications pointing to Propriety of Cessation; Symptoms 
due to Over-nursing— Relief of Symptoms; Arrest of Secretion of Milk; 
General Treatment; Local Applications. 

With most mothers a considerable portion of the period of conva- 
lescence from confinement is occupied, and most agreeably occupied, in 
administering to the nutrition of the new-born infant ; and the remark 
may reasonably be made that information with reference to the func- 
tion of lactation should have appeared in the previous chapter. The 
importance of the subject, however, it may be urged, claims a separate 
chapter for itself ; and as the adaptation of the breasts for this func- 
tion commences some time before confinement, while their utilization 
for the nourishment of the infant usually continues for many months 
after complete convalescence, the propriety and convenience of a dis- 
tinct chapter relating to lactation seem fully justified. 

As a general rule, it may be said that it is the duty of every mother 
who can do so to suckle her own infant. It is a duty which she tacitly 
accepts when she undertakes the other responsibilities inherent to mar- 
ried life, and on its proper fulfilment may depend largely the future 
health of her child. 

Exceptions : Constitutional Obstacles. — To this general rule 
there are some exceptions, involving considerations relative respectively 
to the health of the mother and of the child. 

There are some conditions of health in the mother which may ren- 
der it injurious for her to undertake the fatigue and strain of nursing 

her baby. The propriety of refraining from nursing will generally be 

85 . 



86 THE MOTHER IN RELATION TO THE INFANT. 

indicated by the medical attendant ; but it may be stated that the 
existence of any chronic disease affecting the general health, and more 
especially the presence of any tendency to consumption, renders nur- 
sing distinctly prejudicial to the mother. 

In the interest of the infant, also, it may be desirable sometimes to 
abstain from nursing. There is no doubt that children inherit constitu- 
tional taints, such as predispositions to scrofula, rickets, or consumption 
from their parents ; and there is strong evidence that these hereditary 
peculiarities, when inherited from the mother, are increased in intensity 
if the infant is nourished by its mother's milk during the early months 
of life. In cases, then, where the mother suffers from any marked 
constitutional taint of this character, it is proper for her to sacrifice, in 
the interests of the child, the pleasure she might enjoy from nursing it ; 
and to submit to the alternative of employing a wet-nurse, or by having 
the infant brought up by hand, according to the advice of her doctor. 

Insufficient Secretion of flilk. — Again, a considerable number 
of mothers are physically unable to nurse their infants on account of 
the secretion of milk being altogether wanting, or so deficient in quan- 
tity as to be insufficient for the due nourishment of the child. This 
deficiency does not seem invariably to depend upon the condition of 
the general health, for it is not unfrequently observed in mothers 
apparently perfectly healthy in other respects. Conditions of life seem 
to have some influence in the matter, for it appears undoubted that this 
incapacity for nursing is noticed more frequently among the richer 
classes, and among those living in towns, than among the poorer 
classes, and those whose residence is mainly in the country. 

Inability on the Part of the Infant. — Sometimes also an infant 
will exhibit a dislike to being nourished by its mother, and will refuse 
to suck the breast properly. In some cases, this will be found tr ~ye 
due to a difficulty arising from the shape of the mother's mpplc ? but 
in other cases, apparently, the dislike arises from some peculiar quality 
of the milk, which is distasteful to the child. When a child refuses to 
suck the breast, it is, of course, always necessary to be certain that it is 
not incapacitated from doing so by any malformation of the mouth or 
nose 

Development of Lacteal Secretion. — From a very early period 
of pregnancy some enlargement of the breasts is generally observable, 
as has been pointed out in Chapter III. ; and not unfrequently the en- 
largement is accompanied by an occasional slight watery discharge 
from the nipple. More exceptionally, the discharge is of a distinctly 
milky character. From one tcthree days after confinement the breasts 
usually become- very full and tense, the tension sometimes being so 
great as to give rise to considerable discomfort. At the same time, 
often some degree of headache is experienced, and the temperature of 



CONCERNING SUCKLING OR NURSING. 8; 

the body may be somewhat raised, while sensations of thirst, due to 
the slight fever, are complained of. These symptoms, which are caused 
by the physiological excitement of the breast associated with the rapid 
secretion of milk, are relieved when the infant succeeds in partially 
exhausting the breasts by sucking ; and frequently the relief is in- 
creased by an almost continuous slight flow of milk from the breasts 
during the intervals of nursing. 

It is always very desirable that the infant should be induced to 
suck the breast regularly at intervals before this tension and fulness 
manifests itself. It is proper to place the child to the breast as soon 
after its birth as its mother is able to receive it, and to repeat the pro- 
cess every two or three hours, as it-is found that the stimulus of the 
baby's sucking induces the breasts of the mother to fulfil their function 
in secreting milk. Another reason for so doing is found in the fre- 
quently undeveloped condition of the nipple in women who are nursing 
a child for the first time. Often the nipple does not project at all from 
the surface of the breast, and the child has much difficulty in obtain- 
ing any hold upon it. Immediately after the confinement, the breasts 
are usually somewhat lax, and during that period it is much more easy 
for the child to draw out the nipple than it would be if its efforts were 
commenced only when the breasts are tense and full." 

The Process of Sucking is mainly, but not altogether, a mechan- 
ical one. The infant seizes the nipple of the mother between its 
tongue and the roof of its mouth, and causes a temporary partial 
vacuum by drawing in its breath ; at the same time, it presses upon 
the base of the nipple with its gums and its lips. The suction 
acts in the same manner as an exhausting pump upon the small tubes 
in the mother's breast which contain the milk ; the milk being pushed 
by the compression of the external air toward and into the mouth of 
the child. This is the purely mechanical part of the action ; but in 
addition there is assistance from physiological muscular action. The 
tubes containing the milk in the breasts have muscular fibres in their 
walls which contract and press out the milk when stimulated by the 
sucking action of the child's mouth, and these contractions have some- 
times so much effect that the milk is actually squirted into the infant's 
mouth more rapidly than it is able to swallow it. This reflex influence, 
as it is called, on the milk-tubes not unfrequently affects not only the 
breast the child is sucking, but also the other one, so that it is not un- 
common to observe a discharge of milk from one breast, while the 
child is exhausting the other. 

Depression of the Nipple.— When the nipple is so flat or de- 
pressed that the efforts of the child to seize it are ineffectual, some 
means must be resorted to to draw it out, and thus second the efforts of 
the infant to obtain nourishment. The best method of doing this is by 



SS THE MOTHER IX RELATION TO THE INFANT. 



Fig. 15. 



the use for a few days of an artificial nipple fitted on to a glass shield. 
which, when slightly lubricated with vaseline round the edge, will 
adhere to the breast around the nipple, and permit of strong suction by 
the child. The nipple should be attached to the glass without any 
intervening india-rubber tubing, which when used is exceedingly diffi- 
cult to keep clean. 

When, even with the assistance of this nipple and shield, the infant 
is unable to draw milk from the breast, either the nurse or the mother 
must herself draw out the nipple with the aid of an exhausting breast= 
glass. The most convenient apparatus for this purpose consists of a 

glass nipple-shield forming part of 
a small glass reservoir, to the upper 
end of which a piece of in dia rubber 
tubing is attached, long enough to 
reach to the mouth of the mother 
when the shield is placed upon the 
breast over the nipple. When the 
mother or nurse exhausts the air in 
the reservoir by means of the tube, 
the nipple is drawn into the shield, 
and the milk drawn from the breast 
runs down into the deeper part of 
the reservoir. When some quantity 
of milk has been obtained in this 
way, it may be given to the baby 
either by transferring it to a bottle, 
or more simply, by replacing the 
india-rubber tubing with an india- 
rubber artificial nipple, through 
which the infant may suck the 
milk. It is well always immediately 
after drawing out the nipple by either of the means described above 
to apply the baby to the drawn-out nipple, and induce it to suck, so as 
to maintain and increase the improvement obtained. Sometimes, Im- 
pressing gently on the breast toward the nipple, the mother or nurse 
may induce greater exertion on the part of the baby by giving it the 
stimulus of feeling the flow of milk. Even at the very early age of one 
day, infants often show considerable signs of irritation when, with all 
their efforts, they fail to obtain any reward in the form of milk ; and 
some patience and coaxing may be required to induce the infant to 
fulfil its share of the act of obtaining nourishment. Patience and time 
are well spent in obtaining the end sought, for the nourishment of the 
child never proceeds so satisfactorily when the use of artificial nipples 
has to be resorted to for any length of time. 




EXHAUSTING BREAST-GLASS. 



TENDERNESS OF THE NIPPLE. 89 

If the artificial nipple and the breast exhauster have both been 
inefficacious in improving the condition of the nipple, an older baby, 
when available, may be utilized to exhaust the breasts, and will occa- 
sionally succeed in drawing out the nipple after artificial means have 
failed to effect an improvement. 

Tenderness of the Nipple.— The early efforts of the infant to 
seize the nipple often result in some pain and discomfort to the mother, 
and not unfrequently the tender skin covering the nipple becomes some- 
what raw and sore. For the purpose of obviating this, some women, 
for two or three weeks before confinement, attempt to strengthen 
and harden the skin of the nipple by bathing it two or three times a 
day with whiskey or brandy or eau-de-Cologne somewhat diluted with 
water. It is doubtful if this method of preparation for nursing is of 
much value ; and sometimes it is positively injurious, making the skin 
so hard that it cracks, and presents tender fissures when drawn out and 
pressed on by the mouth of the baby. On the whole, it is best to leave 
the breasts untouched until after confinement, and when suckling is 
commenced to be very careful always to bathe and afterward dry the 
nipples thoroughly with a clean handkerchief or soft towel immediately 
after the infant has ceased nursing. If any rawness or soreness is pres- 
ent, a simple salve such as cold cream [or the Magnetic Ointment, see 
page 1228] may be applied after the nipple has been carefully dried. 
Any salve thus used must be removed by sponging before the child is 
again allowed to take the breast. 

When fissures of some depth are caused in the nipple by suck 
ling, it may be necessary for two or three days to resort to a glass 
shield during nursing, so as to give the fissure time to heal. The appli- 
cation of one or two coats of flexible collodion over the fissure assists 
much in giving the rest necessary to effect a cure. Fissures of this 
kind often bleed to some extent when the child is suckling, and when 
the blood is noticed on the mouth of the infant, it may lead to an erron- 
eous impression that it is due to some disease of the child. Occasionally 
the baby will swallow some of the blood ; and if it becomes sick 
afterward, the vomited blood may excite much alarm. An examina- 
tion of the breast and the detection of the fissure will explain the occur- 
rence and reassure the anxious mother. 

When the secretion of milk after confinement is at the commence- 
ment characterized by much fulness, tension, and discomfort of the 
breasts, relief will generally be afforded by the employment of some 
laxative medicine. The most eligible for this purpose is compound 
licorice powder or castor-oil. Saline purgatives, otherwise very useful 
in relieving tension of this khid, are ineligible on account of the fact 
that they generally act severely on the infant as well as the mother, 
being conveyed to the infant bv means of the milk. At the same time, 



9 o THE MOTHER IN RELATION TO THE INFANT. 

the mother should somewhat restrict her diet, abstaining for a day or 
two from much meat, and from all stimulants, and limiting the amount 
of fluid nourishment. Relief will be obtained also b\ r having the 
breasts gently rubbed two or three times a day with olive-oil [or Mag- 
netic Ointment], the rubbing being directed from the base toward the 
nipple. In the intervals of rubbing, a cool lotion made of equal parts 
of eau-de-Cologne or rectified spirit and water may be kept applied 
over the breasts on a folded handkerchief or piece of lint. When the 
flow of milk from the breasts in the intervals of nursing continues to 
such an extent as to render the clothing wet and uncomfortable, the 
application of some absorbent wool tissue will absorb the superfluous 
milk, and conduce to the comfort of the mother. The wool tissue must 
be changed as often as necessary. 

Insufficiency of ililk. — Sometimes the amount of milk secreted 
by the breasts will be found to be insufficient for the wants of the 
infant. Instead of becoming very full and discharging some milk 
from the nipple, the breasts will remain more or less flaccid, and when 
pressure is made upon them only a little watery fluid exudes. In such 
cases some efforts should be made to increase the flow of milk before 
suckling is given up as being hopeless. Increased richness of diet, and 
the drinking of considerable quantities of milk, will often afford ma- 
terial improvement in the quantity and quality of the milk secreted. 
Some drugs seem to have a beneficial action in this respect, and will 
occasionally be prescribed by the doctor in attendance. It should never 
be forgotten that the most powerful stimulus to the secretion of the 
breast is afforded by the sucking of the child ; and even where milk is 
small in quantity, the child should be put to the breast at regular inter- 
vals, any deficiency being supplemented by artificial means only after 
both breasts have been exhausted by the infant. 

Frequency in Suckling. — The frequency with which an infant 
should be nursed by its mother will vary somewhat with the quantity 
and quality of the milk, and with the robustness and appetite of the 
child. Generally speaking, for the first month or two of life, an infant 
requires to be nursed at least once every two hours during the daytime, 
and once every three or four hours during the night. If the secretion 
of milk is abundant, the intervals may be lengthened a little ; while, 
even if the quantity is not very great, it is seldom desirable to nurse 
more frequently than every hour and a half. When the child is five or 
six weeks old, efforts should be made to lengthen the intervals of nur- 
sing during the night ; often at the end of two months an interval of 
five hours can be obtained during the night, which is a very great boon 
to the mother. When the child has attained three months, the inter- 
vals during the day can often be increased to three hours, while at 
night the child will frequently sleep five or six hours without requiring 



INFANTILE INDIGESTION. 



91 



the breast ; and those intervals will usually be maintained until the 
child is weaned. Exceptionally, in the later months of nursing, some 
children will sleep throughout the whole night without requiring to be 
fed, but this is unusual ; and a mother may consider herself fortunate 
if, after nursing her child when she goes to bed about ten o'clock, she 
is able regularly to enjoy unbroken rest until four or five o'clock in the 
morning. If the infant at that time demands food, it will usually go 
to sleep again afterward, and a further rest may be obtained until 
eight or nine. 

Signs of Indigestion. — If an infant is healthy, and the milk of 
the mother satisfactory, it is usually perfectly quiet and comfortable 
immediately after nursing, and in its earlier days generally inclined for 
sleep. 

If, however, it is restless, obviously uncomfortable, and inclined to 
cry, it may be concluded that either the digestion of the infant or the 
quality of the milk of the mother is at fault. Very frequently the 
cause of the discomfort is found in the stomach of the child being 
overloaded with milk, and distended to such an extent as to interfere 
with digestion. 

When the supply of milk is generous, many infants habitually 
ingest more than they are able to accommodate or digest. Usually, 
after a few minutes, relief is afforded by vomiting, and the superfluous 
contents of the stomach being thus disposed of, the infant settles 
down in comfort to digest what remains. In infants the act of vomit- 
ing seems to be painless and not unpleasant ; and, unlike what occurs 
in older people, only the superfluous amount, not the whole contents of 
the stomach, is evacuated by the process. Many infants are in this way 
habitually sick after nursing, and yet make most satisfactory progress, 
and continue in perfect health. It is possible, of course, when an 
infant overloads its stomach in this manner, to withdraw it from the 
breast before it has reached the point of satiety ; but the infant usually 
resents this, and shows its resentment by loud crying. A rather more 
satisfactory manner of dealing with the difficulty is found in partially 
exhausting the breast with a breast-pump before allowing the baby to 
nurse ; it will then usually be tired of sucking before it has been able 
to extract sufficient milk to overload its stomach. Rather more effort 
on the part of the child is required to obtain milk as the breast becomes 
gradually exhausted ; and the infant seems to cease sucking when the 
effort appears out of proportion to the result obtained. When hungry, 
a baby will exert itself strongly to obtain milk from a breast compara- 
tively empty, while, when partially satiated, it will scarcely suck at all 
even a breast moderately full. 

As a rule, only one breast should be employed for each meal of 
the child, the breasts being alternately used. By this means it is much 



9 2 THE MOTHER IN RELATION TO THE INFANT. 

more easy to prevent the nipples suffering from injury ; and the baby 
is usually satisfied at less cost to the mother. It is found that the milk 
first discharged from the breast is somewhat richer in quality than that 
secreted later. In exhausting fully one breast at a meal, the infant gets 
first the richer milk with slight exertion, then milk of a poorer quality 
with somewhat greater exertion ; and the temptation which presents 
itself to take too much is lessened. If, on the other hand, the baby is 
taken away from one breast before it is exhausted, and presented to 
the other, it again gets the richer milk with comparatively slight 
trouble, and is very apt to take more than its stomach can properly 
accommodate. 

Circumstances of course may present themselves where it is desir- 
able to utilize this difference in the secretion and discharge of the milk. 
Thus, if an infant is not very strong, and easily gets tired when nur- 
sing, it may be desirable to remove it from one breast before it has ex- 
hausted it, and place it to the other, so that it may have a larger and 
richer meal without much fatigue or exertion. 

If the secretion of milk is not very copious, and the infant strong 
and robust, even from very early days it may demand the contents of 
both breasts at one meal ; and probably the majority of nursing moth- 
ers find that after four or five months of nursing the contents of both 
breasts are not too much for the capacity of the child. At that time 
from birth, however, the intervals of nursing will usually have length- 
ened considerably, so that the exhaustion of both breasts will not be 
such a tax upon the strength of the mother as it would have been in 
the earlier days of maternity. 

There can be little doubt that some children are born with a ten- 
dency to painful digestion. Cases are met with where no apparent fault 
can be found with the milk, and where the evidence of marked growth 
and progress indicate the satisfactory nourishment of the child ; and 
yet where every act of nursing is followed by some discomfort and 
pain. Careful examination of the excretions of the child will in such 
cases give no indication of imperfect digestion, and when indiscretion 
in diet on the part of the mother has been excluded, the existence of 
exceptional irritability of the stomach must be suspected. Before 
accepting this as an explanation, however, one should be fully satisfied 
that no other possible source of discomfort is present. The possibility 
of over-richness of the milk and of over-filling of the stomach should 
be kept in view ; and the excretions of the bowels and kidneys should 
be examined frequently so that assurance is felt at to their perfectly 
healthy condition. Many cases of apparent irritability of digestion will 
be found to be caused and maintained by some error or peculiarity of 
diet on the part of the mother. The stomach of the most healthy 
infant is a very sensitive organ, and will often resent the intrusion 



DISCOMFORTS OF THE BREAST. 93 

kjl milk affected in character by articles of diet which have not caused 
any discomfort to the mother. Mention has been made of the facility 
with which saline medicines taken by the mother are absorbed by the 
infant through the breasts. In like manner infants are found some- 
times to be affected by raw fruits, such as strawberries or cherries, 
eaten by the mother, or by acid fluids, such as sherry wine, or vinegar 
used in dressing salads, or in sauces. In all cases where irritability of 
digestion is present, thorough inquiry should be made into the diet of 
the mother, and experiment should be made as to the effect of absti- 
nence for some days from any article of diet of doubtful propriety. 
When the mother herself is conscious of discomfort in digesting any 
special food, no doubt can exist as to its prejudicial influence on the 
child ; and no true mother will hesitate to abstain from any article of 
diet when she knows that by doing so she can shield her infant from 
discomfort and pain. 

Discomforts of the Breast.— When the breasts are full of 
milk, they will often be remarked to be somewhat tense and lumpy, 
and there may exist a general feeling of tenderness on pressure upon 
them. The tension and tenderness will be found to disappear, as a 
rule, entirely when the breasts have been exhausted by the infant. 
Sometimes it may be observed that at some limited spot in the breast a 
feeling of hardness remains, or it may be that an actual small swelling 
may be perceived, which remains somewhat tender to touch. This 
swelling is usually the result of some impediment to the escape of milk 
from this particular part of the breast. The attention of the doctor 
and the nurse should be called to any abnormality of this kind, as there 
is a risk that if attention is not given to it, it may eventuate in abscess. 
If the tenderness is marked, or if the breast feels at all weighty, care 
should be taken to avoid injury by supporting the breast either on a 
pad inside the corset, or by means of a handkerchief tied round the 
neck, and passing under the breast ; and the swollen and tender part 
should be rubbed gently two or three times a day with a little olive-oil [or 
Magnetic Ointment]. By those means it will usually be found that the 
size of the swelling will gradually diminish and the tenderness decrease, 
and generally, in a period varying from a few days to a fortnight, all 
anxiety about the condition of the breast will have disappeared. In 
exceptional cases, however, instead of becoming smaller the swelling 
will tend to increase, the tenderness will continue, and the skin over 
the swelling may become somewhat reddened. When this occurs, and 
when further a little pitting of the skin is noticed on pressure of the 
finger over the swelling, no doubt can remain that the imprisoned milk 
has become decomposed, and that an abscess has developed, and meas- 
ures have to be taken to promote its speedy evacuation. 



94 THE MOTHER IX RELATION TO THE IXFAXT. 

Abscess of the Breast does not always come on in this slow and 
gradual manner. Sometimes, on the contrary, the pain in the breast 
may come on suddenly, accompanied by feelings of cold, and even 
shivering, succeeded by feverishness and restlessness. Again, occa- 
sionally the shivering and feelings of cold precede any pain in the 
breast ; and it is only by careful examination of both breasts that the 
medical man may be able to determine to what the fever is due. In 

Fig. 16. 




MAMMABT GLANDS SHOWING COURSE OF MILK-TUBES TO THE NIPPLE. 

acute cases of this kind, from a very early period, redness of the skin 
of the breast covering the seat of inflammation is usually noticeable, and 
the pitting on pressure of the finger can generally be made out early. 
The pain and tenderness are often accompanied by considerable throb- 
bing, and a sense of much increased weight. 

The fact that these acute abscesses of the breast usually commence 
with feelings of cold, and a tendency to shiver, often gives rise to the 
erroneous idea that exposure to cold has been the exciting cause of the 
inflammation. It is, however, exceedingly doubtful if exposure to cold 
is ever alone the cause of ncute ansr-p^s of the breast. Mention has been 



ABSCESS OF THE BREAST. 95 

made previously of the cracks or fissures which sometimes develop ou 
the nipples at the commencement of nursing. In addition to the dis- 
comfort which these cause, there is good reason to think that to their 
existence is due most of the acute abscesses which occur in the breast 
during nursing. They afford, as it were, an entrance or doorway 
through which impure matter may enter into the breast, and set up 
the acute inflammation which terminates in abscess. The important 
fact to notice in relation to this is, that it is not apparently the existence 
of the fissures which causes the inflammation ; it is the entrance through 
the fissures of impure matter which may possibly have formed in the 
fissures themselves, but which may also have been conveyed into them 
by unclean hands, or clothes, or applications. The obvious lesson is to 
emphasize the great importance of absolute cleanliness during nursing, 
and this even when no apparent fissure exists. A fissure or crack in 
the nipple, so small as to give no inconvenience and to be unobservable 
without close examination, may be quite large enough to admit the 
entrance of impure matter sufficient to generate an abscess. For this 
reason, therefore, as well as for others already mentioned, the practice 
of bathing the nipple carefully after each time of nursing should be 
rigidly adhered to. As a rule, it is quite sufficient to use clean warm 
water for the purpose ; but when any fissure or erosion of skin exists, 
it is safer to use for mixing with the water some antiseptic soap. [Or 
a soap-suds made with Boracic Acid Soap, No. 31 of the Sanitary 
Bureau list. See page 1230. The Magnetic Ointment is useful also to 
aid healing of fissures.] 

When it becomes obvious from the tenderness, the redness, and the 
pitting on pressure that a swelling of the breast is developing into an 
abscess, the two objects of treatment are to limit the size of the abscess 
as much as possible, and to evacuate the contents as quickly as possi- 
ble. The greatest comfort is usually obtained from the application of 
warm linseed poultices, and from frequent fomentation with very warm 
water. At the same time, the breast should be carefully supported by 
a handkerchief passed underneath it, and tied round the neck in the 
form of a sling, and care should be taken to prevent all pressure from 
clothing. In some few cases the application of ice tied into a water- 
proof bag and laid on the seat of the abscess gives more relief than the 
warm application ; and there is no objection to its employment when 
found, effective in relieving pain and subduing inflammation. An ordi- 
nary sponge-bag, half-filled with broken ice and closed carefully by a 
large cork being tied into the open end, may be used advantageously 
for this purpose. When, in the opinion of the doctor, the time has 
arrived for letting out the matter contained in the abscess, the patient 
should courageously nerve herself to permit of the small operation 
necessary for her relief. She should remember that it is for the benefit 



9 6 THE MOTHER IN RELATION TO THE INFANT. 

of her health generally, as well as for the preservation of the breast, 
that the enclosed matter should be released, and that her power of 
future nursing may be impaired by delay. By various methods the 
slight incision required to open the abscess may be made almost with- 
out pain, and the escape of the matter will always be followed by 
great and immediate relief. 

At some period during the formation of an abscess in the breast 
the question will generally arise, whether nursing is to be continued or 
given up. In this matter the mother must be guided entirely by the 

Fig. 17. 




CROSS BANDAGING FOR ABSCESS OF BREAST. 



advice of her medical attendant. In the majority of cases, even after 
abscess has formed in one breast, it is not only possible but desirable to 
continue to nurse with the other, while, if an abscess is small and heals 
rapidly, it may be possible to resume nursing even with the breast in 
which the abscess has occurred. In some cases, the extent of the 
abscess and considerations relative to the health of both the mother and 
infant will dictate the cessation of nursing, and steps will have to be 



WHEN TO WEAN THE INFANT. 



97 



taken which will be described later to arrest and prevent the secretion 
of milk. 

The length of time during which nursing may be continued 

varies much in different mothers. As a rule, the flow of milk will con- 
tinue from six months to a year after childbirth ; in some exceptional 
instances it may be found to last from eighteen months to two years. 
If the mother remain in good health, and the infant appears to flour- 
ish, nursing may be continued with safety as long as the secretion of 
milk in the breasts persists. It will generally be found that after eight 
or nine months' nursing, if not before that time, the amount of milk 
secreted will be inadequate to the wants of the infant, and the diet 
will have to be supplemented by the addition of some artificial food. 
The progress of the infant must be carefully watched, as it cannot 
be depended on to exhibit signs of discomfort from hunger when only 
the quality of the mother's milk has deteriorated, if, at the same time, 
the quantity is maintained. It may usually be presumed, when a child 
without any appearance of illness ceases to gain weight and to grow 
properly, that some error or deficiency exists in the diet, which calls 
for correction or addition. 

The propriety of ceasing to nurse her infant may be indicated 
to the mother in various ways. Most commonly the secretion of milk 
becomes diminished, sometimes gradually, sometimes somewhat rap- 
idly, and it becomes obvious that even when sucking strongly the baby 
obtains but little milk, and that with difficulty ; and in consequence 
exhibits, by crying, signs of dissatisfaction and hunger, which are only 
appeased by the administration of additional food. No rush of milk 
into the breast is felt by the mother such as she frequently experiences 
when the breasts are secreting copiously, and even after a few hours' 
cessation from nursing the breasts will be noticed unfilled and flaccid. 

Not unfrequently the first indication that nursing has been per- 
severed in sufficiently long is afforded by some symptoms of deterioration 
in the health of the mother. She may feel languid and incapable of 
exertion, become somewhat thinner, and look pale and bloodless, and 
suffer from headaches and loss of appetite. A very characteristic 
symptom of the depression of health due to long nursing is the presence 
of pain in the back between the shoulders, usually intensified imme- 
diately after the baby has been nursed. 

When either the failure in secretion of milk, or the deterioration 

of general health, indicates that the question of ceasing to nurse the 

infant must at least be considered, before a final decision is arrived at it 

is usually desirable to try if assistance can be given to the mother by a 

more nutritious diet, or by medical tonic treatment. Frequently it will 

be found that nursing may be continued for a month or two' longer it*' 

some addition is made to the diet, or if some slight stimulant is taken 
4 



9 8 THE MOTHER IN RELATION TO THE INFANT. 

with meals. For this purpose a basin of thick soup with some toast or 
bread should be taken in the forenoon between breakfast and the mid- 
day meal ; and some light farinaceous food made with milk, taken 
immediately before going to bed, is most useful. [A light gruel of 
barley or oatmeal suffices well for this extra food-supply.] Some 
tonic medicine, in addition to the more liberal diet, aids in in- 
creasing the quantity and improving the quality of the milk, and in 
restoring the health of the mother. This will usually be prescribed by 
the medical attendant. 

If the increased diet and tonic treatment just described have no 
beneficial effect within a few days after their commencement, it must 
then be concluded that weaning the child has become inevitable. 

Sometimes the flow of milk in the breasts is arrested quite sud- 
denly by some shock. When this occurs, it is very exceptional for it 
to be restored, and cessation of nursing follows as a matter of necessity. 

Not uncommonly, nursing comes to an end because the infant de- 
clines any longer to take the breast. This generally occurs when some 
artificial food has been used to supplement the milk of the mother. 
The child seems often to take a dislike to its mother's milk after a time, 
preferring the artificial food ; and may refuse entirely to suck the 
breast, sometimes crying when its mouth is placed in contact with the 
nipple. It is probable that in most cases of this kind some alteration 
has taken place in the mother's milk, rendering it unpalatable, as gen- 
erally infants show a strong preference for the breast over any kind of 
artificial food. 

The Recommencement of Henstruation is generally consid- 
ered an indication that nursing should cease. While nursing, mothers 
do not, as a rule, have any menstrual periods ; and the reappearance 
of the menstrual flow is usually accompanied by some alteration in the 
milk, which causes pain and discomfort to the baby. When this dis- 
comfort is not great, nursing may be persevered in ; but if the men- 
strual flow returns in the month following, it is wise, both in the inter- 
ests of the child and the mother, to terminate the nursing. If perse- 
vered in after two successive periods of menstruation have been 
noticed, the mother is likely soon to feel the strain of nursing in dete- 
rioration of health, while the milk she supplies is seldom appropriate to 
the wants of the child. 

There are no doubt a few instances where mothers menstruate 
regularly during the process of gestation, and apparently without any 
ill effects to themselves or their infants, but such cases like those where 
menstruation persists during pregnancy, are entirely exceptional. 

Weaning. — When the resolution to give tip nursing has been made 
for any reason other than the cessation of the flow of milk, some meas- 
ures will usually be called for to arrest \he secretioPj and to prevent 



SUGGESTIONS FOR WEANING. 99 

any injury or discomfort to the mother from the cessation of the 
function of the breasts. Sometimes it is possible to evade discomfort 
by making the process of weaning a very gradual one, lengthening 
by degrees the intervals of nursing, while artificially supplying 
the wants of the child. When some little time can be allowed to 
the weaning process, it will usually be found that after a week or two 
of lengthening intervals, nursing can be given up altogether without 
any discomfort beyond perhaps an occasional sense of fulness in the 
breasts, and it may be a slight discharge of milk from the nipples, 
which will generally be found to cease entirely after two or three days. 

When, however, suckling has to be given up immediately, without 
time for preparation, some difficulty may be experienced in arresting 
the secretion, and maintaining the breasts in comfort, and free from 
excessive distention. The mother should for a few days be very ab- 
stemious in diet, taking no stimulants of any kind, and very little meat. 
A light farinaceous diet is to be preferred, with a moderate allowance 
of milk ; much fluid of any kind is to be avoided. Some saline medi- 
cine, such as a seidlitz powder or a large teaspoonful of effervescing 
citrate of magnesia, should be taken in water every morning ; and 
if this does not act sufficiently on the bowels, it should be supple- 
mented by a compound rhubarb pill, or a teaspoonful of compound 
licorice powder taken at night. Some drugs, notably belladonna and 
iodide of potassium, have considerable effect in reducing the flow of 
milk, and may be prescribed by the medical attendant. 

As a local application to the breast, for the purpose of arresting 
the secretion, eau-de-Cologne, diluted with an equal quantity of water, 
is very effective. It is best applied to the breasts on lint, which, satur- 
ated with the eau-de-Cologne and water, should be laid over the whole 
breast, and covered with some cotton-wool. Whiskey or gin may be 
employed as substitutes for eau-de-Cologne, being almost equally 
effective, if not quite so pleasant in odor. Where the breasts are not 
too tender to admit of a little gentle pressure, the application of a broad 
flannel bandage round the chest outside the cotton-wool will assist 
much in preventing the secretion and promoting the absorption of the 
milk. The flannel bandage should be wide enough to cover the breasts 
completely, and should be drawn as tightly as is consistent with com- 
fort, and secured with safety-pins. Sometimes gentle rubbing of the 
breasts will be found of great use in arresting the flow of milk. The 
rubbing should be in the direction from the nipple toward the base of 
the breasts, and should be continued for ten minutes or a quarter of 
an hour at a time, and repeated two or three times daily. It is conven- 
ient to use some oily material to facilitate the rubbing, and for this 
purpose either plain olive-oil or camphorated oil may be employed. 

The local application of belladonna is of much value in promoting 

LofC. f 



ioo THE MOTHER IX RELATION TO THE INFANT. 

the absorption of milk in the breasts, and its use may be conveniently 
combined with the rubbing described above. To this end liniment of 
belladonna may be mixed in equal parts with the camphorated oil. 

When the breasts are too tender to bear any rubbing, belladonna 
may be painted over them in the form of a glycerine composed of 
equal parts of plain glycerine and extract of belladonna. This glycer- 
ine should be applied twice or thrice daily, and the breasts covered 
afterward with cotton-wool or lint, pressure with a flannel bandage 
being used in addition when it can be borne with comfort. Belladonna 
may also be used in the form of a plaster, cut to the shape of the 
breast, and made to adhere to its surface. When this method is em- 
ployed, care must be taken to cut an opening in the plaster for the 
nipple, so that any exuded milk may escape without difficulty. 

By a selection or combination of these various methods of reducing 
and preventing the secretion of milk, the process of weaning can gener- 
ally be effected in a few days with comparatively little discomfort. 
There is no reason for the mother to lay up or abandon her usual occu- 
pations during this period, but care should be taken to avoid cold and 
over-fatigue, which might be injurious by exciting a tendency to in- 
flammation in the breasts. 



v 




FROM JOHN ROGER'S STATUETTE. 



PART III 



THE CHILD. 



CHAPTER XI. 

Nobmal Development of the Child. 

Average Size and Weight at Birth; Variations; Description of Skin; Of Head : 
Sutures of Head; Fontanelles; Cry; Grasp; Animal Heat; Necessity ot 
Warmth; Tendency to Sleep; Action of Bowels and Kidneys; Meconium ■ 
Normal Excretion of Bowels; Secretion of Kidneys; Indication of Disorder; 
Recurring Craving for Food; Average Rate of Growth in Height and 
Weight; Increase in Intelligence; Development of Sight and Hearing; 
Tears and Smiles; Amount of Sleep; Process of Teething; Development of 
Walking Powers; Art of Speech; Second Dentition; Absorption of First 
Teeth; Puberty in Girls; Menstruation; Occasional Discomfort; Necessity 
of Care during Period; Caution in Use of Stimulants; Manifestations of 
Mental and Moral Disorder; Puberty in Boys; Nervous Derangements. 

The size and the weight of infants born at full time vary within 
fairly wide limits. The average weight of a new-born male infant is 
about seven pounds, of a female infant about six and a half pounds, 
while their height or length averages about eighteen inches, the male 
averaging a little more than the female in height as well as in weight. 
First children not unfrequently fall short of this average, and infants 
born at full time under unfavorable circumstances may occasionally 
be found to weigh only four or five pounds, and to measure not more 
than sixteen inches. On the other hand, a weight and size considera- 
bly above the average is not unfrequent, babies being often found to 
weigh nine or ten pounds at birth, and to measure twenty-one or 
twenty-two inches. Instances of weight much beyound this are rare ; 
the very extreme recorded is a male child about eighteen pounds in 
weight and thirty-two inches in length. 

When first born the skin of the infant is of a pale red color, and is 

often covered with a whitish-yellow greasy material, which is washed 

off by the nurse before the baby is dressed. When the skin has been 

101 



102 



NORMAL DEVELOPMENT OF THE CHILD. 



washed, it will be observed to be covered with fine downy hair, the 
fineness of which varies much in different children. While sometimes 
the down is so fine and short as to be observable only on close inspec- 
tion, frequently it is very distinct, giving a markedly furry character 
to the surface of the skin. If a baby is healthy, and born after the 
full time of pregnancy has elapsed, its limbs are firm, plump, and 
elastic, and its body well covered with fat, so that the underlying 
bones are well concealed. It has well-developed nails on its fingers 
and toes, the naiis reaching fully to the ends of the extremities to 
which thev are attached. 



Fig. IS. 



Fig. 19. 





THE LOOSE-JOINTED SKULL OP AN INFANT. SHOWING THE ANTERIOR PONTANELXE 
i a : THE POSTERIOR FONTANELLE (b) : SAGITTAL SUTURE I e"> : CORONAL SUTURE 
(d); FRONTAL BONE^ 1 : PARIETAL OR SIDE BONES (2); AND OCCIPITAL BONES (3). 

In proportion to the body, the head of a newly born infant appears 
large, forming generally about one-fourth of the total length of the 
child. If the infant is healthy and strong, the head is firm and well 
. shaped, and the attachment to the body by the neck is strong and 
resistant. If an infant is weakly, the head is usually found rather 
flaccid, and its shape is easily altered by pressure, while the neck 
appears feeble, and sometimes thin, and lengthened by muscular relax- 
ation. At birth the bones enclosing the brain are not rigidly united as 
they are in adult life. The exterior of the skull is made up of a 
variety of bones rather loosely attached to each other, and admitting 
of considerable alteration of the shape of the head under pressure. 
This capacity for alteration is of great value during childbirth, as it 
permits of the head adjusting itself to the irregularity of the passage 
through which birth takes place. The lines along which the bones 
are joined to each other are generally visible to the eye at birth and 
are always distinguishable by touch; they are known technically as 
sutures. The principal of these sutures are known as the co-ronal 
suture, the sagittal suture, and the occipital suture. The coronal one 



CARE OF THE NEWLY BORN INFANT. J03 

can be felt and seen across the top of the head in front just behind the 
forehead. The sagittal suture extends along the crown of the head, 
from the middle of the coronal suture in front, to a point in the centre 
of the back of the head, where it meets the occipital suture. The 
occipital suture is angular in shape, the point of the angle being 
directed to the posterior end of the sagittal suture, and the sides diverg- 
ing downward and outward from thence. The sutures are simply 
spaces between the bones of the head, occupied by soft cartilage ; and 
it is mainly the hardness of the bones on each side which renders them 
so obvious to touch. At either end of the sagittal suture the spaces 
become somewhat wider, and two small areas of softness become appar- 
ent, which are known under the name of fontanelles. The anterior 
of these is of a diamond shape, and varies in size in different infants 
from a diameter of half an inch to one of two inches. The posterior 
one is triangular in shape, the sides of the triangle measuring from 
half an inch to one inch or more in length. As the infant grows, these 
fontanelles are gradually filled up by growth of bone, and in a healthy 
child at the end of two years will be found to be obliterated. Their 
importance from the present point of view is found in the indication 
they afford of the progress in development and health of the infant. 
In weakly infants the fontanelles are often found to close very slowly, 
and may occasionally be observed even to increase in size for a few 
months after birth, instead of gradually diminishing. The mobility 
permitted by the existence of sutures and fontanelles frequently admits 
of considerable apparent obliquity of shape of the head during the first 
few days of life. During childbirth the head of the child is often 
much altered in shape, and immediately after birth one side of the head 
may be observed larger than the other, or the forehead may seem 
much flattened and the back of the head lengthened. Such alterations, 
resulting as they do from pressure before birth, need not be regarded 
with any anxiety, as in a few days the elasticity of the head will restore 
the natural contour, and all traces of pressure will disappear. Healthy 
babies born at full time usually cry lustily immediately after birth, 
the cry being often the first indication of their independent existence. 
At this early stage it is probably caused by the discomfort arising from 
sensations of cold. In the womb tbe infant is surrounded by a watery 
fluid with a temperature of about 100° F. ; on birth it is ushered into an 
atmosphere which rarely exceeds 60° F., and the baby's appreciation of 
the reduction of temperature is often indicated by marked shivering as 
well as by loud crying. The crying and shivering usually cease imme- 
diately that the child is enveloped in a warm blanket. Some discom- 
fort in addition is felt by the child from the absence of general support 
to the body after birth. "While in the womb some pressure is exerted 
on all the surface of the child's body by the pressure of the abdominal 



104 NORMAL DEVELOPMENT OF THE CHILD. 

muscles of the mother acting through the medium of the amniotic 
fluid ; after birth this sense of pressure and support is lost. That its 
loss is felt by the infant is evinced by its restlessness even when kept 
perfectly warm, unless some support is given to it by blankets or 
pillows, and also by the strong tendency of newly born infants to 
grasp firmly with the hand anything with which they may come in 
contact. A newly born child seems to have an absolute dread of being 
left without any support, and clings tenaciously to the apron of the 
nurse or to the blanket in which it may be rolled. If a baby is strong 
and well nourished, its grasp is firm, and it moves both its arms and 
legs with activity. When maintained in proper warmth, its hands and 
feet are found to remain warm and natural in color, the face looks pink 
and healthy, and the breathing is regular and full. If exposed much 
to cold, however, even a strong baby will soon show signs of lessened 
vitality. The fingers and toes will become blue and cold, the face 
somewhat pinched, and the nose pale, and the breathing somewhat 
shallow ; and when the child cries the voice will be found feebler and 
the cry more moaning in character. These alterations invariably indi- 
cate the necessity of great care in maintaining warmth, and may call 
for the early attention of the medical attendant. 

During the first one or two months of a child's life, almost the 
whole of its time is devoted to sleep, except when occupied in receiving 
food. The tendency of a healthy infant under two months old is to 
fall asleep immediately after taking nourishment, and to remain asleep 
until it again wakens under the stimulus of hunger. This rhythm is 
liable to interference from various causes, the most common of which 
is discomfort in digestion. A considerable proportion of babies suffer 
from some discomfort after taking food, and indicate the fact by rest- 
lessness, by frequent crying, by flatulence, and by occasional sickness. 
Whatever discomfort a baby suffers from, it inclines to attribute to 
hunger, and if the opportunity is given to it, it will always try to allay 
the discomfort by the imbibition of food. This is apparently the result 
of a healthy instinct. A healthy baby properly tended ought to know 
of no discomfort except hunger, and when discomfort of any kind 
exists it instinctively refers it to this cause. It is for the more expe- 
rienced nurse or mother to differentiate between the causes of discom- 
fort, and to apply the proper remedy. Too frequently the discomfort 
resulting from indigestion is mistaken for hunger, and the disorder in- 
creased by the administration of more food before the previous meal 
has been healthily disposed of. 

Generally both the bowels and the kidneys of a newly born 
infant act once or twice during the first twenty-four hours of life. The 
first one or two actions of the bowels differ from the subsequent ones, 
being generally very dark in color, sometimes almost black. What 



GROWTH AND PROGRESS. I05 

passes from the bowel at this time is known technically^, as meconium, 
and consists of secretions from the liver and bowel during intra-uterine 
life. After the meconium has passed away, and the baby has been fed 
once or twice with milk, the motions become yellow in color, and of 
the consistency of thick cream. This color continues during the first 
one or two years of life, becoming gradually slightly darker. The 
motions are usually unformed during the first few months of life, 
consisting merely of a uniform mass, unless the form has been modified 
by constipation, when hard lumps of fseces may be passed. On an 
average, a young baby's bowels will act three or four times in the 
twenty-four hours. At the same time two good motions daily are quite 
compatible with perfect health, while five or six actions daily would 
not be considered abnormal if the character of the motions remained 
quite healthy. Anything beyond that would be considered excessive, 
and would probably call for some alteration in diet. The excretion 
from the bowel of a healthy infant has a very slight odor ; marked 
fetor of the motions is always indicative of some failure in digestion, 
or some error in diet. 

The Secretion from the Kidneys in infants is usually of a very 
pale color, is not irritating to the skin with which it comes in contact, 
and imparts almost no smell to the diapers which absorb it. The 
bladder is emptied with very varying frequency in different children. 
Five or six times daily is usual ; in children who take nourish- 
ment very freely, eight or ten times a day is not uncommon. No 
amount of frequency need excite anxiety if the urine appears normal 
in quality. Indications of disorder are found in fetor of the diapers, 
increased depth of color, presence of small quantities of red sand, and 
irritation of the thighs of the child. The presence of a small quantity 
of sand or gravel in the urine of very young babies is only very occa- 
sional, and is not to be viewed with any anxiety ; but if it occurs at all 
frequently, some alteration of diet is necessary. Irritation and redness 
of the thighs of a child ought always to call attention to the condition 
of the urinary secretion. It may of course occur when the urine is 
perfectly healthy, if the diapers are not changed with sufficient fre- 
quency, but in a well-tended child its existence will always excite the 
suspicion of some unhealthy condition of the urine. Nurses are some- 
what apt to blame the washing of the diapers when irritation of this 
kind occurs ; the possibility of this source of irritation can always be 
tested by making use for a week of diapers washed at home, or of the 
cotton-wool and gauze diapers sold under the title of "bapkins." 

Growth and Progress. — Every healthy child is born with a 

periodically recurring craving for food, evinced by a tendency to 

suck anything placed between its lips, and a readiness to swallow any 

thing pleasing to its tongue or palate. If its lips and mouth and nose 
4a 



io6 



NORMAL DEVELOPMENT OF THE CHILD. 



are properly formed, and its breathing power good, it can suck even 
from its earliest days with considerable effect, and evidently de: 
much pleasure from exercising this function if a due reward is obtained 
in the form of a satisfactory supply of milk. Obtaining this, and exer- 
cising its other functions healthily, the young infant usually grows 
with considerable rapidity. Often an increase of weight of four to six 
ounces weekly will be observed ; sometimes even half a pound may be 
gained in one week. The progress in weight is seldom quite nniform : 
in one week a great advance may be made, while in the next compara- 

AVERAGE HEIGHTS AXD WEIGHTS OF CHILDREN. 
(Adapted from r, 'A Text-Book of Hoia>~ Physiology." 

BY LaISDOIS A2TD STIRLING.) 



Age in years. 


Height in Inches. 


Weight in Pounds. 


Males. 


Females. 


Male- 


Fena'.es 


At birth 

2 

3 

4 

5 

6 

7 

8 

9 

10 
11 
12 
13 
14 


27^ 

3ii ; 

34 " 
361., 
39 " 

41 

43-., 
46 " 
45 

O'-'-o 

52 " 
58% 

55 " 
55 


19 
27 
31 

33- 2 
36 

as 

43 

45 
47 
49 
50 
52 
54 


i 

29 
33 

39-o 

57i 2 
61 

65-. 

77-.; 

59 " 


20-, 

25 

27-. 

31 

34 

mi 

4-y-o 

45-: 
49-: 

53-1 

571; 

67 
76 
833/ 



tivelv small progress is noticed. On an average, during the first year 
_ iin of more than twelve pounds is observed, perhaps two-thirds of 
which may be made in the first six months, the increase in weight 
beins: somewhat slower as the child grows older. Children who are 
over the average weight at birth generally progress for the first one or 
two vears with greater rapidity than those who have been born under 
the average weight. Coincidently with increased weight, increas : in 
height or length is observed ; during the first year a gain of eight or 
nine inches in length is usual. Durir._- the second year of life increase 
of weight and height does not progress at such a rapid rate ; the 
usual increase of weight during this period is from four to five pounds, 
while the stature increases by four or five inches. A: nd of the 

second year, speaking generally, about four pounds is added to the 



FIRST INDICATIONS OF INTELLIGENCE. 



107 



weight yearly, while the height is increased by a little more than two 
inches annually. A table of average measurements of weight and 
height at different ages of both males and females is shown opposite. 

First Indications of Intelligence. — In the early days of infancy, 
a baby cannot be said to manifest much intelligence. Although 
usually opening its eyes immediately after birth, its power of vision is 
very slight, and a finger can be approached close to its eyes without 
exciting them to wink. It is only after two or three weeks existence 
that it will be observed to follow with its eyes any bright light moved 
in front of them ; and few babies will recognize the individual faces of 
the mother or nurse until at least two months old. If before this age 
the baby cries when carried by one person rather than by another, 
it is due to differences in the comfort of the manner in which it is 
held, rather than to personal preferences. Many nurses take consider- 
able care to protect the eyes of infants from bright light, but this care 
is usually quite unnecessary, except when the baby may be suffering 
from actual inflammation of the eyelids. The eyelids of newly born 
infants are somewhat prone to inflammation, resulting usually from irri- 
tation received during the process of birth ; and it is quite a mistake 
to attribute the inflammation of the lids to any exposure to light. 
Babies from two to four months old use their eyes to greater purpose, 
and will often be found capable of recognizing the faces of their 
mother and father, and will cry on being confronted with a strange 
face. 

At from three to six months of age they will look about them 
freely, and will be attracted by any bright-colored article, and will 
attempt to seize with the hand objects held in front of them. 

The faculty of hearing in infants usually requires some time for 
development. It is true that from the commencement of life an infant 
will start when any very loud noise is made, but this is more probably 
due to the general shock from vibration than to any special auditor)' 
sense. It is seldom that a baby will seem to regard any special sound 
until it is about three months old. At that age it may be found to 
turn its head at the voice of its mother or nurse, and may show its 
attention drawn by the striking of a clock. From that age onward 
many babies seem to be soothed by the singing of their mother, and 
some infants of six months will show distinct pleasure at the sound of 
music, and interest in the ticking of a watch held to their ears. 

Babies, as has been observed more than once, are capable of crying 
from the moment of their birth, and few of them are backward in 
exercising this power. Although able to cry, they have not, however, 
for one or two months the ability to shed tears. After crying for a 
little time the eyes of a very young infant may be noticed to be moist, 
but the flow of real tears from a baby's eyeg is seldom observable until 



lo8 NORMAL DEVELOPMENT OF THE CHILD. 

it has attained the age of three months. Babies smile when very 
young ; a distinct, pleased smile may often be elicited by tickling or 
patting the face of a baby one month old, but audible laughter is very 
uncommon in infants under five or six months of age, and many chil- 
dren never laugh heartily until they have attained the age of one year 
or mure. 

Sleep. — Babies vary considerably in the amount of sleep they can 
take and enjoy. During the first month of life generally an infani 
sleeps almost continuously, except when nursing or being fed or washed. 
When more than a month old, it will often lie awake for one or two 
hours at a time, quite happy if in comfort, especially if lying in the 
nurse's lap or carried in her arms. "When two or three months old. if 
a fairly strong child, it will begin to sit up a little in the nurse- : 
mother's arms, its back becoming firmer, and the neck beariDg the head 
well when a little support is given by the arm. 

At this age it will remain awake for two hours or more at a time : 
and when it reaches the age of six months it may remain awake for 
three or four hours, sleeping only for an hour or two in the forenoon 
and afternoon, and continuouslv during the ni^ht. From the very 
commencement of life it is always well, as far as possible, to induce the 
infant to sleep all through the night, with only intervals for feeding. 
No doubt this is not unfrequently a matter of some difficulty -. and 
with some young infants it is impossible, wakefulness at night being 
not uncommon during the first few months of existence. But patient 
effort in soothing the infant, combined with attention to keeping it 
awake and interesting it during the day. will often overcome the ten- 
dency to nocturnal wakefulness, and the mother will gain the reward 
of her cares in the enjoyment of peaceful nights. 

From eight months to a year old an infant will generally sleep two 
or three hours in the forenoon, remaining awake after its forenoon rest 
until six or seven in the evening This sleep during the forenoon will 
often be continued during the first two or three years of life, and 
should always be encouraged. While at the age of one year it may 
last for two or three hours, as the child becomes older the duration 
may be shorter, but even if the sleep only lasts for one hour in the 
middle of the day. it is of much value to a child of two years old or 
even more. 

From earliest infancy until at least the fifth year, the night's re:?t 
should be as nearly as possible one of twelve hours. Generally speak- 
ing, the child should be undressed and put to bed before seven in the 
evening, and should not be taken up and dressed again until after seven 
in the morning, the disturbance for feeding and for other purpose* 
during the night being effected as gently as possible. Even in very 
young infants there should be a change of clothing before lying down 



PROCESS OF TEETHING. I09 

for the night's rest, and this change should be made at the same hour 
every evening. 

Process of Teething. — Babies do not as a rule begin to cut any 
teeth. until they have attained the age of six or seven months. At birth 
the gums are smooth and moderately soft, although firm, and they gen- 
erally remain in this condition for three or four months. They may 
then be observed to become somewhat less smooth, and a little swollen 
toward the front of the mouth ; and the apparent increase of fulness 
is frequently accompanied by increased secretion of saliva, and a ten- 
dency to "dribble." This condition may continue for a month or two 
before any teeth can be felt projecting under the surface of the gum, 
during which time the baby usually exhibits a strong tendency to bite 
anything which is placed in its hand, in default of which it frequently 
employs its own fingers. The teeth which usually erupt first through 
the gums are the two central ones in the lower jaw; and these are 
generally followed in two or three weeks by the corresponding ones of 
the upper jaw. As a not unfrequent exception, the upper ones appear 
before the lower ones. These teeth which appear in the middle of the 
upper and lower jaw are known as the central incisors. Although 
appearing as a rule about the seventh month of life, they not unfre- 
quently are observed to erupt two or three months earlier ; occasionally 
babies are born with them fully developed, but such instances are very 
exceptional. On the other hand, the eruption of the teeth may be- 
considerably postponed, and infants are not uncommonly seen who have '• 
attained the age of twelve months without the eruption of any teeth. 
When the cutting of the first teeth- has been delayed as k,ng as a year 
from birth, there is generally ground for suspecting some slight weak- 
ness of health ; and this suspicion is strengthened if coincidently with 
the late eruption of teeth exceptional openness of the fontanel ies of the 
head is observed. Too much importance must not, however, be at- 
tached even to the coexistence of these two indications of dilatory 
development ; but their presence may suggest the propriety of medi- 
cal advice as to conditions of diet arid hygiene which may promote the 
general health and more rapid progress of the infant. 

Some two months after the central incisors have erupted, the front 
teeth at each side of them, which are calied the lateral incisors, usually 
make their appearance, the ones in the lower jaw more generally ap- 
pearing before those in the upper jaw\ At the age of twelve months or 
soon afterward the first double teeth come through the gum, occupying 
places some little distance behind the lateral incisors, from which 
they are separated by a space destined for the appearance somewhat 
later by the canine or eye teeth. The double teeth are known techni- 
cally as molar teeth, and the ones which come through first and lie 
behind the spaces for the canine teeth are termed the anterior molar 



HO NORMAL DEVELOPMENT OF THE CHILD. 

teeth. They are somewhat broad on the top, unlike the incisor teeth, 
which have a sharp knife-like edge, and are furrowed slightly, having 
a ridge on the outside and inside, and a hollow between the two ridges. 
The ridges often break through the gums separately, leaving the fur- 
row covered by the gum for a few days longer, and present the decep- 
tive appearance of two teeth side by side until the bursting of the gum 
discloses the furrow uniting them. 

The canine or eye teeth usually appear when the child has attained 
the age of from eighteen to twenty months. They come in the spaoe6 
between the lateral incisors and the anterior molars, occupying the 
angles of the mouth, and are more pointed than any of the other teeth. 

The first set of teeth of the child is completed by the eruption ot 
the posterior molar teeth, which appear behind the anterior molar teeth 
generally about the end of the second year of life. The posterior molar 
teeth, like the anterior, are double teeth with two ridges and a furrow 
on their opposing surfaces. 

From the description given it will be seen that the first set, or, as 
it is often called, the "milk" set of teeth of a child, is made up of 
twenty teeth, symmetrically arranged in the upper and lower jaws. 
Recapitulating their names from the centre in front toward the sides, 
there are the upper and lower, right and left central incisors, lateral 
incisors, canine or eye teeth, anterior molars, and posterior molars. 
The incisors and canines have each one root in the jaw, the lower 
molars have each two roots, while the upper molars have each three 
roots. 

It is not very uncommon to observe a departure from the usual 
order of the eruption of the teeth, and no importance is to be attached 
to irregularity in the sequence of eruption, if average progress is made 
as regards the number of teeth cut at different stages between six 
months and two years of age. One frequent irregularity is the appear- 
ance of the anterior molars before the lateral incisors ; another common 
variety from the usual order is the eruption of teeth in the upper jaw 
before the corresponding teeth, in the lower jaw, instead of some little 
time after. A much more unfrequent abnormality is the absence alto- 
gether of lateral incisors, sometimes only in one jaw, sometimes in 
both. When this occurs, the oentral incisors are generally separated 
from each other by a small space, as if apparently to occupy as well as 
possible the space in the gum originally intended to accommodate four 
teeth. 

Development of Walking Powers. — During the first six months 
of its life, an infant has practically no power of locomotion. It is en- 
tirely dependent upon its mother or nurse for the supply of its wants, 
being unable even to approach its mother to seek for sustenance, unless 
it happens to be lying in close proximity to her. This inability is due 



CREEPING AND WALKING. HI 

probably more to the absence of intelligence in directing the muscles 
than to actual weakness of the muscles themselves. Immediately after 
birth an infant often exhibits considerable muscular strength, grasping 
firmly with its hands, moving its arms, and kicking or curling up its 
legs. But for some months it is unable to employ this muscular power 
for any useful purpose. The first indication of a growing sense of the 
power of locomotion is usually observed in the baby "feeling its legs" 
when taken up in the mother's arms. If held under the arms by the 
mother while sitting down, a baby of six months will often rest its feet 
on its mother's lap, and, when encouraged, will place one foot in front 
of another, walking as it were toward its mother's face. When a 
month or two older, if laid on the floor, and tempted by any article 
held just out of reach, the infant will usually attempt to crawl a little 
on its hands and knees, first stretching a hand out, and then following 
with one leg if the object has not been attained. At from nine to ten 
months of age many infants will begin to try to stand beside a chair or 
sofa, by holding which they can assist in sustaining themselves. Hav- 
ing attained an erect posture by careful adherence to the chair, the 
enterprising infant of ten months will cautiously move one leg after 
another round the chair, always taking care to maintain its hold of the 
friendly support. Continuing to educate its muscles by crawling, by 
climbing and by occasionally falling and picking itself up again, in the 
course of a month or two the child will begin to walk a little without 
support, and when a year has elapsed from birth may have entered on 
the higher sphere of existence as an animal possessed of locomotive 
powers. Children, however, vary much in the age at which they first 
are capable of walking without assistance ; some will not attain the 
faculty until they are eighteen months or even two years old, while 
some exceptionally advanced infants will walk unassisted when they 
have only attained the age of ten months. There is no reason what- 
ever to be anxious about any moderate delay in the development of 
walking powers in an infant, if in all other respects it appears quite 
healthy. In this faculty as in others there is great variety among 
children both in the manner and the rapidity of acquisition. Some 
infants never pass through the preliminary stage of crawling, learning 
to walk, by clinging to the legs of chairs and tables or by assistance 
from their mothers and nurses, without ever resorting to the apparently 
more simple quadrupedal method of progression. Others again, appar- 
ently preferring the crawling to the walking method, will persist in 
employing it for purposes of locomotion for some months after they 
might reasonably be expected to resort to the more advanced and intel- 
ligent erect posture. At the age of two years every healthy child 
should be able to walk with steadiness and facility ; and when the 
power of walking is not developed at that age, the possibility of the 



H2 NORMAL DEVELOPMENT OF THE CHILD. 

existence of some physical or mental defect should present itself to the 
parents, and lead them to obtain competent medical advice in the 
matter. 

Speech. — The acquirement of the art of speech usually accom- 
panies more or less contemporaneously the development of the facul- 
ty of walking. At from four to six months old many babies can 
articulate distinctly the vowel a. which is the most easily pronounced 
of all the vowels ; and when one or two months older the addition of 
one of the labial consonants, b, m, n. p can usually be effected. It is 
more eas}- for the infant to prefix the consonants than to suffix them, 
and accordingly the words pa, ma, na, or the reduplication of these in 
papa, mama, and nana, precede considerably in time the words am or 
an. Other single words of one syllable are gradually added to the 
vocabulary, which usually consists of a considerable number of words 
before any attempt is made to combine them in a short sentence. A 
child of one year old can generally pronounce a few words of one sylla- 
ble, but is rarely able to combine two consecutive syllables in one 
expression. The small muscles of the larynx by which the sounds are 
produced are acquiring slowly and laboriously their education, just as 
the larger muscles of the leg in walking ; and combined movements in 
both cases are much more difficult than simple ones. Children gener- 
ally find it more easy to pronounce two syllables of one word consecu- 
tively than two words of one syllable, the slight rest between the two 
words seeming to necessitate a fresh effect which is not required when 
the syllables immediately succeed each other. By the age of eighteen 
months most infants will be able to express some meaning by two or 
three short words spoken consecutively ; and when the ag3 of two 
years has been reached many children will be found to have a fair 
command of short sentences. But the variety in progress in this 
respect in different children is quite as noticeable as in their walking 
efforts. Some infants are exceptionally quick in the attainment of lan- 
guage, speaking with some intelligence at the early age of eighteen 
months ; others again do not attain to much command of speech until 
they have completed their third year. It is rather exceptional to find 
early development of the faculties both of speech and of walking in one 
infant; more frequently a baby who is forward in one direction is 
somewhat backward in the other. When the health of the child is 
satisfactory, and evidence of intelligence in other respects apparent, no 
anxiety need be felt about any backwardness in the attainment of 
speech, if the sense of hearing is ascertained to be sufficiently acute. 
No difficulty presents itself in doing this : a baby of six months old, if 
its sense of hearing is perfect, will have its attention attracted by the 
tone of a bell or by the voice of its mother, and will show the fact by 
its expression and attitude. 



MENTAL PROGRESS OF THE CHILD. n 3 

Intelligence. — With the acquisition of the power of speech comes 
gradually the sense of the meaning of the words pronounced. Even 
before the child can itself pronounce the words ma and pa, it begins to 
identify their sound with different individuals, and other words when 
learned are associated with the objects to which they apply. The sense 
of number can usually be observed in infants between one and two 
years old, who will be found to distinguish between small numbers 
such as two and three or four, and who may themselves be able to 
count up to five or ten. About the same time also they will be found 
able to distinguish between colors, calling them by their proper names, 
and selecting particular colors when asked to do so. In regard to 
appreciation of music, very marked differences are observed in young 
children. Some babies at a very early age will exhibit preferences for 
particular tunes, and will at the age of two years be found to identify 
airs by associating them with names. When the faculty is markedly 
developed, children from two to three years old will not unfrequently 
be heard to sing airs quite correctly. On the other hand, many chil- 
dren equally intelligent in other respects exhibit no appreciation of 
differences of tune, and no faculty of repeating airs even at a much 
more advanced age. On the whole, it must be admitted that the devel- 
opment of the musical faculty in children, as perhaps also in older 
people, bears no apparent relation to the cultivation of the intelligence 
generally. From the end of the third until the sixth year of life the 
healthy child is found to progress rapidly in development and intelli- 
gence, exercising its powers of observation, and storing its memory 
with the facts conveyed to its mind by its various senses. At this age 
children are specially receptive and acquisitive, and seldom require oi- 
bear well the stimulus of regular teaching. The observation of every- 
day life, the information conveyed by communication with older people, 
and the restless energy in finding out things for themselves usually 
give sufficient occupation for the brain, which is apt at this age to 
resent pressure, and to suffer from any undue strain. 

Second Dentition. — At about the age of six years children usually 
commence to develop their second or permanent teeth. The first of 
these to appear are four double teeth, which are situated immediately 
behind the posterior molars of the first or milk set of teeth. The time 
of their appearance is very irregular ; sometimes they will come 
through the gum before the age of five years has been reached ; in 
other children their advent may be postponed until the seventh year 
has been completed. In most cases the lower ones appear first ; not un- 
frequently there may be an interval of some months between the erup- 
tion of the lower ones and the upper ones. They are known as 'the first 
permanent molar teeth. Following these, at about the age of seven 
years, the permanent central, incisors push their way through the gums, 



1 1 4 NORMAL DEVELOPMENT OF THE CHILD. 

displacing before them the temporary central incisors, and causing 
them to drop out. The process of removal of the temporary teeth to 
make room for the permanent ones is rather interesting. As a perma- 
nent tooth grows toward the edge of the gum, it pushes against the 
root of the temporary tooth in front of it, and causes its absorption. 
This absorption proceeds to such an extent that frequently the whole 
root of the temporary tooth disappears, nothing being left of the tooth 
except the crown adhering to the surface of the gum. As the absorp- 
tion of the root progresses, the temporary tooth becomes more and 
more loose, and when the process is completed the tooth is so little 
attached to the gum that it may be displaced entirely by a slight move- 
ment of the tongue. The edge of the tooth, where the process of ab- 
sorption has ceased, is often very sharp, and from this frequently the 
mistake is made of supposing that the temporary tooth has been 
broken off, leaving its root in the gum. This, however, is never the 
case, except from actual violence ; in all cases where the tooth hi is 
become loose and fallen out. it results from the absorption of the root 
due to the pressure of its underlying permanent successors. The cen- 
tral permanent incisors are followed in about a year by the lateral per- 
manent incisors; and these again, at about the age of nine years, 
by the successors of the anterior temporary molars, which in a 
permanent set are not molars, but are known as the first bicuspid 
teeth. About a year afterward, between the ninth and tenth 
years of life, the posterior temporary molars are succeeded by the 
second bicuspid teeth, situated immediately behiud the first bicuspids, 
and directly in front of the first permanent molar teeth. These bicus- 
pid teeth are strong teeth with a somewhat rigid top, and a single root 
grooved on each side, indicating as it were a tendency to become 
double. In the eleventh year the permanent canine or eye teeth usually 
make their appearance. They are very large, strong teeth, and have a 
marked tendency in many children to project forward from the gum ; 
in some cases actually growing almost directly outward. The upper 
canines very often cut through the gums very high up, and grow 
downward in front of the roots of the temporary canines in place of 
pressing against their roots and causing absorption. When this occurs, 
a very unsightly projection of the permanent teeth results, and it be- 
comes necessary to extract the temporary teeth to allow of the perma- 
nent ones falling back into their proper places. Something of the same 
kind happens not unfrequently with the lower canine teeth, and meas- 
ures have to be resorted to to regul. tc t eir position. From the sit- 
uation of the canine teeth at the angles of the mouth, the personal 
appearance and expression is affected more by them than by any of the 
other teeth ; and during their development the propriety of consulting 
a dentist as to their regulation will often present itself. Not unfr*. 



THE AGE OF PUBERTY. 



U5 



quen-tly the space left between the lateral incisors and the first bicus- 
pids is insufficient to admit of the canines occupying their proper 
position, and some measures have to be taken to afford space for them, 
either by the extraction of one of the permanent teeth, or by the appli- 
cation of some mechanism to distend the jaw. 

During the twelfth year or a little later the second permanent 
molars usually develop, appearing immediately behind the first molars. 
The molar teeth of the permanent set, like those of the milk set, have 
a broad surface suitable for grinding food ; the upper ones have each 
three roots, while the lower ones have only two. 

The teeth which come last of all, and complete the permanent set, 
are the wisdom teeth. They are most irregular in the time of their 
appearance, sometimes being found as early as the fourteenth year, 
sometimes not coming through the gum until the thirtieth year, and 
occasionally never developing at all. They resemble in appearance the 
molar teeth, behind which they present themselves, but are smaller and 
have only single roots, which, however, are grooved as if to indicate a 
tendency to separate, in the upper wisdom teeth into three, and in the 
lower into two branches. The permanent teeth when complete will be 
seen to number twenty-eight, made up of right and left, upper and 
lower central incisors, lateral incisors, canines, first bicuspids, second 
bicuspids, first molars, second molars, and wisdom teeth. 

Puberty. — In describing the progress and development of children 
up to the age of thirteen years, it has not been necessary to make any 
marked distinction in regard to sex. Minor differences of weight and 
height between boys and girls have been incidentally referred to, but 
the general description given has applied equally to children of either 
sex. About the age of thirteen or soon afterward, certain conditions 
of development present themselves, which necessitate distinct descrip- 
tion as they occur respectively in male and female children. These 
conditions are associated with the attainment of what is technically 
known as the age of 'puberty, and are intimately related to the elabora- 
tion of the sexual functions. 

In girls, usually between the thirteenth and fifteenth year, sometimes 
somewhat earlier, and occasionally later, a considerable change in the 
figure is observed to occur. The bust becomes fuller and the breasts 
more prominent, while the figure generally is noticed to be more 
rounded and matured. Those physical changes, together with the de- 
velopment of the hair in some parts of the body, are accompanied or 
followed soon by the appearance of menstrual discharge. For some 
months before this appears there is often considerable lassitude, ten- 
dency to aching of the back at intervals, and mental unrest. Frequently, 
girls are at this period of their lives irritable, nervous, and hysterical, 
and the condition of the mind is often peculiar and fanciful. Some-. 



n6 NORMAL DEVELOPMENT OF THE CHILD. 

times the appearance of the menstrual discharge is preceded by bleed- 
ing from other parts of the body. Bleeding from the nose is common ; 
from the lungs in the form of expectoration of blood, and from the 
stomach it is not so usual, but yet not very unfrequent. Expectoration 
of blood is apt to lead to the suspicion of lung disease ; but when it 
occurs at the age of puberty, before menstruation has appeared, or co- 
incidently with its appearance., there may be no indication whatever of 
disease of the lung, or of any tendency to consumption. If such expec- 
toration recurred two or three times at intervals of about a month, the 
presumption would be very strong that it was due entirely to the 
increased blood-pressure resulting from the development of the- men 
strual function. After the first occurrence of the true menstrual dis- 
charge, it generally appears regularly at intervals of about twenty-eight 
days. It is not, however, at all uncommon to find it arrested for two 
or three months after the first appearance, then occurring once again, 
and again intermitting for one or two months. Irregularity of this 
kind in the first one or two years after puberty has been attained should 
not give rise to any anxiety, and does not call forany medical treatment 
if the general health is satisfactory. At this period of life, however, 
the general health is rather apt to fail from slight causes, and any 
departure from health should be watched carefully, and medical advice 
obtained when necessary. More especially at this age a condition of 
poorness of blood known as chlorosis is apt to develop, evincing itself in 
pallor of the face, breath lessness on exertion, lassitude, a"nd depression. 
The Amount of the Menstrual Discharge, and the number 
of days during which it continues at each monthly period, vary very 
considerably in different girls. What would be considered an excessive 
amount in a weak and anaemic girl might be quite normal and health- 
ful in one who is strong and robust. The only way to judge whether 
the amount is excessive or not is by the effect produced on the gen- 
eral health of the individual. The menstrual flow, although it may cause 
a girl to be somewhat pale and languid during its occurrence, should 
not leave any injurious effect on the health after it has ceased ; if it 
does so, either the amount is excessive, or the health is in some way 
impaired. A normal menstrual period may last from two to nine days ; 
generally each period is of the same duration in the same individual. 
The intervals between the periods are also usually very constant in 
the same individual, although varying to some extent in different girls. 
The most usual interval is twenty-eight days, counting from the first 
appearance of one menstrual period to the first appearance of the next. 
This period may in different persons be curtailed to twenty-five days, 
or extended to thirty-two days. Any interval less than twenty-five days 
should be considered abnormal, and medical advice should be sought, 
as ill results are apt to follow too frequent menstruation. There is not 



THE MENSTRUAL FUNCTION. n 7 

the same risk attached to an unduly lengthened interval,' but after the 
flow has been quite regular for some months, any arrest for a month or 
more should call for notice and medical treatment. 

The health and mental condition of girls at this period of life de- 
mand much attention from their mother or other female guardians. As 
the age of puberty approaches it is proper to tell girls of the probable 
appearance of the menstrual flow, and to give them some indication of 
its character and meaning. It is also right to enjoin upon them the 
necessity of care of their health during the menstrual flow, the risk 
which may follow any undue exposure to cold or any severe exertion 
during that period, and the propriety of adopting means to insure 
proper cleanliness. At the same time, it should be pointed out to them 
that the menstrual flow is a normal physiological process, upon the 
regularity of which their general health will to some extent depend, 
and that they ought not to be ashamed to let their mothers or other 
advisers know of any irregularity or any discomfort which may attend 
its appearance. 

A certain amount of discomfort and even of pain is a not very un- 
frequent accompaniment of the menstrual period, and this may be 
present in the absence of any disorder of health or local disease of the 
womb. A great deal can be done to relieve this pain by the use of 
suitable medicines, and by the rest for one or two days of the period ; 
and the slight self-sacrifice which may be involved in abstaining from 
social pleasures during the first one or two days of menstruation 
accompanied by pain will be amply repaid by freedom from subse- 
quent discomfort, and by perfect health during the intervals. At 
this stage of a girl's life it is of much importance that attention should 
be paid to the regular action of the bowels. Constipation is a common 
trouble at this period of life, and is a frequent cause of discomfort and 
pain during menstruation. Where it exists, it is desirable that some 
laxative medicine such as compound licorice powder or confection of 
senna should be taken nightly for two or three days before the period 
is expected. There is no objection to mild laxative medicines, such as 
those mentioned above, being taken even during the menstrual period, 
but it is well at that time to abstain from any violent purgative medi- 
cines, as they are somewhat apt to set up localized inflammation. 

Caution. — Great discretion should be used in the employment of 
stimulants for the relief of pain during menstruation. While un- 
doubtedly in many cases great relief is given by their employment, 
there is very considerable risk of the habit of taking stimulants being 
acquired, and preference should always be given to the application of 
poultices, or flannels wrung out of warm water, to rest, and to sedative 
medicines prescribed by the medical attendant. In a few cases where 
pain is excessive some local treatment to the womb during the interval 



<$*& NORMAL DEVELOPMENT OF THE CHILD. 

of menstruation may be necessary, but this should always be avoided if 
possible, [except when it can be arranged for self application, as in 
many cases it may be.] 

Mental Conditions.— Girls at this period of their life are some- 
what prone to manifestations of slight mental and moral disorder. 
Various symptoms, comprehended under the general application of 
"hysteria" — such as unprovoked fits of laughing and crying, or attacks 
of seeming fainting and convulsions — not unfrequently present them- 
selves, while motiveless acts of mischief, unnatural cravings for abnor- 
mal food, and perverted moral ideas are occasionally met with. When 
phenomena such as these appear, much judgment as well as patience is 
required on the part of the natural guardian of the invalid. Super- 
vision must be exercised, and proper moral principles inculcated, at 
the same time that the physical health is properly attended to. Judi- 
cious occupation, both for the mind and body, is essential, and care 
should be taken in the selection of healthy literature, as well as in the 
choice of suitable companions in recreation. It is at this age that 
morbid inclinations related to the development of sexual instinct occa- 
sionally occur, and a wise mother will always be particularly careful 
of the companions her daughters may choose at this anxious period of 
their life, and will cautiously avoid the possibility of their receiving 
contamination or injury from lax or improper associations. 

Mothers should keep carefully in view the importance of prevent- 
ing too much brain-work during this period. Valuable as is that 
higher education now offered to girls, it may be purchased in some 
cases at too dear a price. Let a mother see that her girls receive a true 
education, the "drawing out" of their mental faculties by gradual and 
healthy means, and let her discountenance everything that savors of 
"cramming." 

The changes which have just been described as occurring at puberty 
in girls are completed usually in a comparatively short space of time. 
Very often in from three to six months an entire change both in 
figure and in character will be effected, and the girl becomes changed 
into the young woman. 

In boys the change which occurs at puberty usually progresses 
much more gradually, and generally some years are requisite for the 
complete development of the boy into the young man. The age of 
puberty is reached by boys rather later than by girls. Most commonly 
it commences in bovs at from fourteen to fifteen years of age. The 
most striking feature is the change in the tone of voice, which becomes 
of a deeper character ; and this is accompanied by increased size of the 
larynx, where the voice is produced, and by projection of that part of 
the larynx known as "Adam's apple." The figure gradually becomes 
more manly, the chest becomes broader, and hair is developed in 



PUBERTY IN BOYS. 



119 



various parts of the body. At this age boys are apt to manifest various 
nervous derangements, as well as slight mental peculiarities. Twitching 
of various muscles, both of the face and of other parts of the body, is com- 
mon, and spasmodic winking is of frequent occurrence. Among mentfi : 
eccentricities the most usual is bash fulness, accompanied by a tendency 
blush on slight provocation ; exceptional sensitiveness and unwonted ii 
ritability of temper are also observed. The physical and mental altera- 
tions are coincident with, and in some manner related to, the develop- 
ment of the sexual function, and care in the selection of companions, and 
supervision as to the employment of leisure, are specially necessary at this 
stage of a boy's life. There is no doubt about the extreme value of 
physical exercise at this critical period ; and the rule which exists at 
most public schools of compelling boys to take their part in foot-ball, 
cricket, and other exercises, unless specially exempted by medical 
order, is founded on a wise knowledge of the constitutional peculiari- 
ties of the age of puberty. 

[The advisability of early instruction of youth in sexual physiology, 
to guard against the prevalent vices of this age, is sufficiently urged in 
the companion volume to this. Also Dr. Foote has prepared in " Science 
in Story " (including Sexual Physiology for the Young), a useful book 
for children, concerning all the functions of the body. See advertising 
pages.] 



CHAPTER XII. 

General Care of the Child. 

Washing of Baby; Temperature of Water; Soaps; Use of Oil; Attention to 
Cord; Dress; Necessity of avoiding Pressure or Restraint; Material of 
Clothing; Diapers; Bassinette; Objection to Baby Sleeping with Mother; 
Desquamation of Skin; Red-Gum; Value of Fresh Air; Sunshine; Daily 
Baths; Value of Douching; Out-Door Exercise ; Carriage in Arms; Bassin- 
ette Perambulators; Importance of Support when sitting up; Walking in 
Open Air; Cultivation of Cleanly Habits; Selection of Clothing; Unreliable- 
ness of Children's Sense of Temperature; Indications of Insufficient Cloth- 
ing; Change of Underclothing at Night; Importance of Looseness of 
Clothing. 

Immediately after birth it is usual to wash the new born infant 
carefully and thoroughly. For this purpose the infant bath described 
in Chapter VII. is very convenient ; in its absence, an ordinary foot- 
bath or a large basin may be employed. The water used should bo 
comfortably warm ; an experienced nurse can decide by testing with 
her hand the proper temperature, but one not experienced would do 
well to make use of a bath thermometer, regulating the temperature of 
the water to 100° F. Any kind of good soap may be employed. Most 
nurses have their favorite soap, which they may have asked the mother to 
obtain beforehand, and the nurse's preference in this matter should be 
respected. For the first ablution after birth a small piece of new flannel 
answers better than a sponge , afterward there is no objection to the 
use of a sponge in the daily bath of the infant. When the skin is much 
covered with the white sebaceous matter referred to in the previous 
chapter, washing is facilitated by rubbing the child first all over with 
either lard or vaseline or olive-oil, which is washed off afterward with 
soap and warm water. In washing, special care should be taken to 
clean thoroughly the folds and hollows of the body, such as the arm- 
pits, the ears, the folds of the thighs, and behind the knees. If any 
sebaceous matter is left in these folds it is apt to decompose and set up 
irritation which may result in inflammation and even ulceration of 
the skin. [As the eyes of the new-born infant are very sensitive and 
the substance on its skin may be very irritating it, has been recom- 
mended that a bandage be applied about the child's head and eyes in a 

way to protect them during the first bath, as illustrated in the accom- 

120 




BABY'S BATH. 



Dan Faux. 



TREATMENT OF THE UMBILICAL CORD. 



121 



Fig. 20 



panying cut. It is a simple expedient, and one which, if carefully em- 
ployed, is likely to prevent many cases of "ophthalmia neonatorum," 
the eye inflammation from birth which has been a common cause of 
blindness, and ought not to be.] 

After being washed thoroughly the infant is dried carefully with a 
warm, soft towel, and then powdered with some harmless absorbent 
powder, such as powdered starch, violet powder, or Fuller's earth. 

Before commencing to dress the baby, some little attention has to 
be given to the part of the umbilical cord 
attached to the navel. It will be remembered 
that after the infant is born this cord is tied in 
two places and cut between the two ligatures, 
one part of the cord remaining attached to the 
child at the navel, and the other part con- 
nected with the after-birth. As the umbilical 
cord is of no utility after birth, it is usual to 
cut it within two or three inches of its attach- 
ment to the infant, leaving just enough of it 
to admit of its being tended properly until it 
drops off. This usually happens in about five 
days after birth. From the time the cord is 
cut it gradually shrinks and becomes drier, 
and begins to detach itself at its connection 
with the skin round the navel ; and this pro- 
cess is usually completed in about five days, 
when the dry and stiffened cord falls off 
altogether. Sometimes, instead of becom- 
ing dry, it becomes soft and putrid, with a somewhat disagreeable 
smell. In such cases there is often a little unhealthy ulceration at the 
line of its separation from the skin, and there is sometimes left, after 
the cord has fallen off, a small ulcerating and projecting surface on the 
navel, discharging a thin unhealthy matter, and giving rise to a slight 
unpleasant odor. 

The most important point with reference to the cord in a new-born 
infant is to be certain that it has been tied so efficiently as not to admit 
of any bleeding from its cut end. Sometimes a very thick cord may 
have been tied quite satisfactorily before being cut, but when cut may 
shrink so that the ligature becomes a little loose, and allows of some 
oozing of blood from the cut end. When there is any appearance of 
this there should be no hesitation in putting on another ligature at 
once. The cord apparently has no sensation, and a piece of tape or a 
few strands of silk thread or cotton may be tied as tightly as possible 
round it without the infliction of any pain upon the baby. It is not 
well to use a single thread or a piece of thin twine for this purpose, as, 




BANDAGED EYE?. 



122 GENERAL CARE OF THE CHILD. 

when the cord is soft, it may be cut entirely through by the single 
thread, and bleeding again recur from the fresh wound. If twine is 
,5t . at all, i: should be of a soft and coarse kind. If there is no oozinsr 
from the end of the cord, it is dusted well with powder, and enfolded 
in a small piece of linen. The most convenient way of doing this is to 
take a piece of old linen (part of an old handkerchief does very well) 
about seven inches by four inches in size. In the middle of this a small 
hole about the size of a shilling is cut, the cord is drawn through this 
hole, and laid flat on the stomach of the child above the navel, with 
one layer of the linen below it, and the other covering it. The sides of 
the piece of linen are then enfolded over the cord, and the whole kept 
in its place by the flannel binder, which is put on loosely round the 
abdomen of the infant. The piece of linen : ight to be changed every 
time that the 3 bathed, great care being taken that no traction is 

made on the cord in bathing or drying the child. If the cord remains 
moist and becomes putrid, some antiseptic powder should be used in 
place of the starch or Fuller's earth ; equal parts of powdered boracic 
acid and oxide of zinc make a very satisfactory powder for this pur- 
pose. If there is any discharge from the navel after the separation of 
the cord, the small ulcerating surface which will come into view when 
the folds of the navel are stretched a little should be dusted twice daily 
with the antiseptic powder just mentioned ; if, in the course of a week, 
it is not entirely well, the attention of the medical adviser should be 
called to it. [Sanitary Powder, So. 37, is applicable for this purpose. ' 
See page 12-30.] 

In dressing a baby it is most important that all its clothes 
; ._ . .: ;-::V.: -7 L ::.= •? . Same nursr? Live aaa iaea '.':.:.: :. ba:. 7 re- 

quires external si from its clothes^ and, accordingly, occasionally 

draw the binder s :> tightly that the infant is unable to breathe prop- 
erly. This view is entirely erroneous, and the practice founded upon 
it very injurious. The two objects of the binder are to prevent the 
remnant of the cord from being injured by movement, and to maintain 
the warmth of the child, and both these objects are equally well 
effected by a loose binder. 

As fevr pins as possible should be used in fastening the clothing of 
an infant, and these should invariably be safety-pins. Where it can be 
done conveniently, stitching should always be employed in preference 
to pins. 

Clothing : Warmth. — Consistently with warmth, the clothing of 
an infant should always be as light and as simple as ]a:ss:::L;- ana 
should be porous, so as to admit of ventilation to the skin. Flannel 
and merino are the two materials which best fulfil these indications, 
Of the two, merino has some advantage, but flannel, if good and pure, 
is quite satisfactory. 



CLOTHING: WARMTH. 12 $ 

It is important that the arms and neck of a baby should be properly 
clothed, as well as the body and legs. The arms and hands of an infant 
are particularly liable to cold, and when the circulation in the arms is 
impeded by chill, the digestion and the breathing are usually effected 
secondarily. Nurses and parents are apt to imagine that if the tempera- 
ture of the room is comfortably warm, there is no risk of the arms or legs 
of a child being chilled when uncovered. It should be remembered, how- 
ever, that while the temperature of even a warm room seldom exceeds 
70° F., the temperature of an infant's body is about 98 5° F., a differ- 
ence of 28°. Many new-born infants, if not very robust, will show by 
blueness of the hands the effects of the arms being left uncovered even 
in a thoroughly warmed room. It has been already remarked that 
^warmth is even more essential than food to the new-born child, and 
especially is this the case with infants who have been born somewhat 
prematurely. Often their one chance of life depends upon the attention 
given to maintain their temperature. So important is this that when a 
child is born during the seventh or eighth month of pregnancy, and 
seems very feeble, it is usual for some days, or even longer, to omit 
altogether the processes of washing and dressing, and to keep the infant 
simply rolled in sheets of cotton-wool, with nothing except its face 
exposed to the external atmosphere. A feeble infant will often make 
progress in this way, the cotton-wool being changed as frequently as is 
necessary to maintain cleanliness. 

A new-born infant is of course unable to let it be known when it is 
about to pass water, or when its bowels are about to act ; and provision 
is made to prevent the soiling of its clothes by these actions in the form 
of diapers which are pinned or tied on to receive the discharges. Those 
diapers ought to be soft and as absorbent as possible, without being too 
cumbrous or warm. The best material for them is Turkish towelling ; 
but ordinary linen or flannel is often employed for the purpose. Sheets 
of absorbent cotton-wool, incased in gauze, have recently been intro- 
duced as substitutes for diapers ; they are convenient, but occasionally 
are objectionable as maintaining too much heat. Diapers must be 
changed as often as is necessary by the frequency of micturition and 
the action of the bowels ; they should never be allowed to remain on a 
baby when wet or dirty. Nurses are occasionally careless in this 
respect, and the neglect results iu redness and irritation of the thighs 
and abdomen of the child, and in considerable discomfort. This red- 
ness and irritation is not unfrequently attributed to improper wash- 
ing of the diapers with soda or other irritant, but the explanation 
in the vast majority of instances, if not invariably, is negligence in 
changing as frequently as necessary. In some cases it is true that an 
irritating condition of the urine or the fasces will conduce very much 
to the production of this inflammation ; but the irritating secretions 



124 GENERAL CARE OF THE CHILD. 

ought not to be allowed to remain in contact with the skin long enough 
to do much injury. 

Waterproof sheeting ought never to be applied external to the 
diapers ; it is injurious to the child in preventing the cutaneous respir- 
ation, and acting as a continuous poultice ; and is only of use in con- 
cealing the necessity for frequent changing, and thus covering the 
laxness of a careless nurse. 

The Cradle. — Every baby should have a cradle or bassinette for 
itself, and should not be put to sleep at night by the side of its mother. 
During the day there is not the same objection to the baby lying at the 
side of its convalescing mother. At that time she is awake, and able to 
see that the child lies comfortably, that it gets pure air to breathe, and 
that it is nursed only at proper intervals. At night, on the other hand, 
the mother ought to be asleep, and if so is unable to attend properly to 
the wants of the child. It may thus have its head covered with blan- 
kets, and breathe all through the night impure air saturated with 
secretions from its mother's body ; or it may be turned round accident- 
ally with its face downward, and be suffocated from inability to 
breathe properly. Another objection to babies sleeping in the same 
bed with their mothers is that they thus acquire bad habits of nursing. 
When put to the breast, instead of exhausting it properly and com- 
pleting its meal, the baby is apt, when allowed to lie all night with 
its mother, to play with the breast, taking a little milk occasional!}', 
then stopping for awhile, and again resuming the process of sucking. 
Often it will continue this for ihe greater part of the night, soon ac- 
quiring the habit of continuing to suck even when more than half 
asleep. In this way it obtains more milk than is good for it, deranges 
its digestion, and at the same time unduly exhausts its mother, who 
wakens in the morning unrefreshed and wearied. When, on the other 
hand, the baby sleeps in its own cradle, it is taken to its mother when 
it cries for food, exhausts the breast, is replaced in its cradle, and 
sleeps quietly until again awakened by the cravings of hunger. It is 
only when a baby is very feeble and in great want of warmth that it is 
right to allow it to share its mother's bed. In such cases the animal 
warmth of the mother is very valuable, and she soon instinctively 
acquires the faculty of taking care of the infant even during her sleep, 
often sleeping for hours at a time, with the infant in her arms, without 
making any alteration in her position to the injury of the child. Here 
the risk of the infant acquiring bad habits of nursing does not present 
itself, as feeble infants seldom or never exceed in the amount of milk 
they draw from the breast ; the difficulty is usually the opposite one 
of inducing them to take enough, and the importance of warmth so 
transcends any other requirement that everything else has to be sacri- 
ficed for that one object. 



FRESH AIR ESSENTIAL. I25 

The Skin.— During the first few weeks of life every baby sheds, its 
external skin. Sometimes this process of desquamation, as it is called, 
is effected rapidly, the skin coming off in large scales, or even in shreds, 
and the shedding being completed within less than a week from its 
commencement. In other cases the desquamation progresses slowly 
;md almost invisibly, only a little roughness of the skin being occasion- 
ally noted, and perhaps a few loose scales detected here and there. 
Not unfrequently some irritation of the skin accompanies the desquam- 
ation, and it may be characterized by small red pimples scattered over 
the body, to which the name of red gum is usually applied. In cases 
of rapid desquamation little patches of old skin sometimes become ele- 
vated so as to resemble vesicles, containing occasionally a little fluid, 
just like the vesicles of chicken-pox. This irritation of the skin seldom 
is sufficiently serious to call for any attention. A little additional care 
in drying the child, so that the towel may not irritate any pimples or 
vesicles, is desirable, but beyond that nothing is necessary, and it will 
be invariably found that the eruption subsides after a few days, and 
leaves the new skin soft and smooth underneath. 

Value of fresh Air. — In addition to warmth, young infants, 
even more than older children, are very dependent for their health and 
growth upon a proper supply of fresh air. Even in strong children 
the power of breathing deeply is comparatively feeble in very early 
life, and it is most important that the air they inhale in breathing 
should be the purest obtainable. If the bodies of babies are kept thor- 
oughly warm, there is very little risk of their catching cold from in- 
spiring cold air. Healthy babies naturally breathe always through the 
nose, keeping their mouths shut, and cold air is warmed by contact with 
\he interior of the nose before it reaches the more sensitive linings of 
the throat and bronchial tubes. Even in winter a strong baby can 
be safely taken out of doors in the arms of its nurse within three or 
four weeks of its birth if the weather is bright and free from cold or 
damp winds. It is usual and judicious at first to accustom the baby to 
changes of temperature by taking it from one room to another ; and 
when it has been thus used to comparatively slight changes, it may be 
taken out of doors for a short period at a time. It is important to note 
that it is much more the duration of exposure to cold than the intensity 
of cold which is likely to injure a young infant. All babies, even 
Aveakly ones, have a certain power of resisting the influence of cold, 
but when the power is feeble it is very early exhausted, and then bad 
results ensue. Exposure to cold air in babies has much the same effect 
on them as indulgence in cold baths on adults. While as short expos- 
ure is stimulating and healthful in its effects, prolonged exposure to 
cold is followed by depression, coldness of the extremities, and ten- 
dency to catarrh of the bronchial tubes or of the stomach and bowels. 



126 GENERAL CARE OF THE CHILD. 

The effects of cold air must be matched by the nurse or mother when 
carrying the infant, and it must be taken indoors when the hands or 
feet are felt to be in the least chilly. When due regard is paid to the 
maintenance of warmth, nothing is more beneficial to young children 
than regular exposure to the open air. The appetite is found to In- 
crease and the color of the infant to improve, more rapid progress is 
made in growth, and the sleep at night is better and less disturbed. 

After the first few days of life a baby of normal strength may be 
carried from one room to another ; and in summer, when from a week 
to a fortnight old, may be taken into the open air for fifteen or twenty 
minutes at a time. In winter it is generally safer to keep the baby 
indoors until it has attained the age of three weeks to a month, and 
then to take it outdoors only when the weather is fine, and when there 
is not much wind. After the outdoor exercise has once been com- 
menced it should be continued as regularly as the weather will permit, 
the duration of the exposure to the open air being gradually increased 
until the baby spends three or four hours daily or even more in the 
fresh external air. For the first three months of their life, at least, 
babies ought to be carried in the arms of their mother or nurse when 
taken out. They are more comfortable in the support given them by 
the arms of the person carrying them than they can be in any peram- 
bulator, and they have the great additional advantage of being kept 
warm by the close contact with another human body. It is, however, 
now usual to put them into bassinette perambulators when they have 
attained the age of about three months. A bassinette perambulator is 
not in any way objectionable for a young baby, if due care be taken 
that it lies properly in it, and that it is maintained in due warmth. The 
advantage of the nurse's arms is that there more stimulus is given to 
the muscular system of the infant, and its growth is thereby promoted. 
But a baby generally is carried about sufficiently within the house to 
gain advantage in this way ; aud the bassinette perambulator, on the 
other hand, has the merit of allowing the infant to be longer in the 
open air, as the nurse does not become fatigued in wheeling it as she 
does when carrying the child in her arms. 

Bassinette perambulators are usually constructed with a well in the 
centre, covered over with a padded board. When the baby reaches the 
age of six to eight months, it will probably object to the horizontal 
position, and the board will have to be removed to allow of the child 
sitting up. When this stage is attained, care must be taken that the 
back is properly supported, cushions being used for that purpose when 
necessary, and that the feet are kept warm, and have something to rest 
on if the well is too deep for them to reach to the floor. The baby 
should also be supported at the side, if the perambulator is a wide one, 
so as not to put any undue strain upon the still rather weak muscles 



SUNSHINE: BATHING. 127 

of the back. When the child has attained the faculty of walking 
fairly well, perhaps about the age of eighteen months, it should be 
taken out of its perambulator for a short time every day and permitted 
to walk a little in the open air. Gradually the length of the walk may 
be increased, and when the child has arrived at the age of two and a 
half to three years, the perambulator may be dispensed with entirely. 
It is not well, however, to dispense with this means of locomotion too 
early. It is most important that the young child should spend a con- 
siderable part of its time in the open air, but at the same time it is of 
equal importance that it should not be unduly fatigued by walking, 
and the perambulator should accordingly be used until the walking 
powers are fairly matured. It will often be found advisable to allow 
the child for some time to walk during the forenoon, and to be driven 
in the perambulator in the afternoon, before discarding its use alto- 
gether. As an aid to outdoor exercise, the recently introduced chil- 
dren's mail-carts are of much value, but they are unsuitable for chil- 
dren under the age of one year. 

Value of Sunshine. — Another important element in promoting 
the vigor of the young infant is a due amount of sunshine. So far as 
possible, the room in which the baby spends the greater part of its 
time should be one which admits as much sunlight as possible. The 
influence of the sun in whatever way it may act, is as beneficial to the 
life of an infant as it is necessary to the life of most plants. It is erro- 
neous to suppose that the eyes of a baby may be injured by exposure to 
bright light. As soon as a baby is old enough to express pleasure by 
signs, it will show its appreciation of brightness, and its eyes are cer- 
tainly not more sensitive thaa the eyes of any ordinary adult, or more 
likely to be injured by sunlight. 

The Bath. — For the first two or three months of a baby's life it 
should be bathed every morning in water of the temperature of 100° 
F. After it has attained the age of three months, the morning bath 
should be cooled gradually, reducing it by about 5° F. weekly, until a 
temperature of 70° F. is attained. In winter the temperature of the 
bath should not be reduced below this degree, but in summer it may be 
reduced until a quite cold bath is given, which in summer represents a 
temperature of about 60° F. Some attention must be paid to the pre- 
dilections of the baby in the matter. Some babies enjoy thoroughly 
the coolness of the bath, and are obviously made brighter and benefited 
by it ; others again resent the diminished temperature, and cry when 
put into it. When this occurs, the temperature must be raised again to 
that preferred by the infant, and more gradual attempts made to slowly 
diminish it. Sometimes, if a baby resents any diminution in the tem- 
perature of the bath, it will not object to a little douching with cooler 
water when sitting in the warm water. This pouching has a very 



128 GENERAL CARE OF THE CHILD. 

stimulating effect, and is very simply carried out. As the baby sits in 
its bath, the nurse pours some cool water from a jug held in her hand 
down the back of the child, letting it fall just below the neck and run 
downward into the bath. As the baby becomes somewhat accustomed 
to it, the jug is held somewhat higher ; and if at first tepid water is 
used, and gradually day by day more cold water is added until water 
entirely cold is employed for the douche, and the height at which the 
jug is held gradually increased, a baby will be found to thoroughly 
enjoy a cold douche on its back from a height of two or three feet. 
The great art in inducing babies to undergo the little shock involved in 
entering a cold bath or in being douched is never under any circum- 
stances to frighten or startle them. Everything must be done gently, 
quietly, and gradually ; and a baby five to six months old can easily 
be led to regard the whole process as a part of its daily amusement. 
The tepid or cold douche can often be used with advantage to babies 
who are not strong enough to bear a cold bath, and it may be continued 
throughout the whole winter, as well as in the summer. An evening bath 
should always be a comparatively warm one, although it is not neces- 
sary to maintain it at the temperature used immediately after birth. 
Speaking generally, it should not be allowed to fall below a tempera- 
ture of 85° F., while 90° F. to 95° F. will usually be more eligible. 
The exact temperature should be decided mainly by the influence the 
bath may have in inducing quiet sleep. [The author exhibits the 
English fondness for cold bathing and douching, and however hygienic 
it may be for the hearty child in its "teens" or the robust adult, our 
idea is that the mother should "go slow" in the effort to cultivate a 
fondness for it in babies. The artistic picture at the opening of this 
chapter is called the Baby's Battle, but if the baby's own feelings are 
duly respected as to temperature, it should rather be the Baby's 
Delight.] 

Cleanly Habits. — It is very important for the comfort both of the 
mother and the child to inculcate as early as possible the propriety of 
cleanly habits. For the first two or three months of life the baby 
discharges the excretions from the kidneys and bowels almost involun- 
tarily, and gives no indication when these discharges are about to 
occur. For this reason it is necessary always to have a diaper adjusted 
to receive them. After the first two or three months the infant is con- 
scious of their occurrence, and the mother or nurse should attempt to 
associate it regularly, morning and evening, and at other times, in the 
baby's mind with some sound. 

When the association has been fully perceived by the infant, it will 
soon progress a step farther, and give notice to the mother or nurse 
when an action is about to take place, by making the same sound 
itself. Foj? the first few months of life the voluntary control of the 



CLOTHING FOR OLDER CHILDREN. 



129 



actions of micturition and defecation is feeble, but this control is in^ 
creased and educated by the child itself when it learns to give notice of 
its desire for relief. Children vary much in the rapidity with which 
they learn this important lesson, but it is not at all unusual to find 
children of only six months old who can be safely left without any 
diaper during the whole day. At night the sensitiveness of the child 
to warnings is diminished, and it is usually necessary to continue the 
employment of diapers throughout the night during at least the whole 
of the first year of life. After six months of age, the infant, instead of 
being held out by the nurse, can be placed upon a low night-stool, 
night and morning, supported, if necessary at first, by its nurse. The 
encouragement thus given to one or more daily actions of the bowels at 
regular hours induces a habit which is of much value in maintaining 
the health in later years. The solicitation of an action of the bowels in 
this way should be continued daily throughout childhood, and should 
be attended to as nearly as possible at the same hour every morning, 
and due care should be taken that a sufficient time is allotted to the 
purpose. 

In the Selection of Clothing for Older Children three points 
ought to be kept in view : the first that the clothes are of such material 
and shape as to fulfil well their function of keeping the body, and more 
especially the arms and legs, warm ; the second, that they interfere as 
little as possible with freedom of movement ; and the third, that they 
are as light as possible in weight consistently with fulfilling their first 
and most important end. For both night and day wear the garments 
next the skin should be of soft, porous, and absorbent material, and 
should be capable of being washed frequently without injury to the 
texture. The materials which answer these conditions best are merino, 
flannel, and woven silk, the first named being the preferable. No 
underclothing for day use is so satisfactory for children's use as merino 
combinations, which should always have long arms reaching to the 
wrists, high necks, and legs coming down below the knees in winter, 
and reaching almost to the knees in summer. These combinations are 
now made in varying thicknesses of merino, and in all sizes, from those 
suitable to children of a year old to those intended for adults ; they are 
not expensive, and, if the material is good, they last well when prop- 
erly taken care of. "With underclothing of this kind, and of a thick- 
ness suitable to the season and prevailing temperature, almost any vari- 
ation may be made in the external clothing according to the taste of the 
mother without risk from cold. In judging of the sufficiency of a 
child's clothing, very little reliance can be placed on its own sensations, 
and the mother must judge for herself by the temperature of the hands 
and feet of the child. It is rare for a healthy child to complain of cold 

even when suffering much from insufficient clothing ; but if a child in 
5 



13° 



GENERAL CARE OF THE CHILD. 



good health comes in from a walk or from a ride in a perambulator 
with hands and feet cold and pale or blue on the surface, it may be 
assumed that in some particular direction the clothing is insufficient, 
and most often it will be found to be the covering of the arms or of the 
legs which is deficient. Very frequently the arms and legs will be 
found cold when the body is quite warm, but the body will never be 
observed to be cold when the arms and legs are warm. The influence 
of cold of the extremities in affecting adversely the digestion has 
already been referred to, and many of the other catarrhal troubles of 
childhood flow from the same cause. A very common mistake made 
in this country is to assume that there is no risk of a child suffering 
from cold when indoors. Many parents who take the greatest care to 
clothe their children warmly when going out of doors allow them when 
indoors to have both arms and legs uncovered, and to be insufficiently 
clothed in other respects. With a changeable climate like that of 
England, [or the United States] there is considerable risk in doing 
this, unless the temperature is carefully regulated. Many cases of 
depressed health in children without any very defined cause are due to 
the influence of cold from insufficient clothing, and it is probable that 
the great frequency of rheumatism in children in this country is due 
much more to the depressing effect of insufficient clothing, acting 
through a long period of time, than to the occasional exposure to severe 
chili. 

For the night wear of children flannel night-dresses are very suita- 
ble, and are perhaps more convenient than merino combinations. 
Merino night-dresses also have been introduced within late years, and 
are exceedingly comfortable and warm. Young children are very apt 
to kick their legs out of the night-dress during sleep, and run a risk of 
chill in this way ; in order to prevent this, it is often well to have the 
flannel or merino night-dress made about a foot longer than the child, 
and to double the bottom over, and pin it with a safety-pin when the 
child lies down in bed, thus enclosing the feet as it were in a bag. 

. It is almost needless to add that no child should ever wear the 
same clothes next the skin during the night which it has worn during 
the previous day. When confined to bed by illness, the night-dress 
should always be changed night and morning, and should always be 
well aired before being put on, in winter in front of a fire, and in sum- 
mer by being hung up in a dry and airy room. 

Children now practically never wear night-caps, although forty 
years ago their use was universal ; and they never suffer in any way 
from their absence. This is due to the fact that the strength of the 
circulation in the head is greater than in any other part of the body. 
Cold in the head is never due to cold on \h% head ; it is| invariably the 
result of chill \u some other region, 



CLOTHING SHOULD NOT BIND. 131 

Caution. — Care should be taken that the clothes of children never 
press unduly on any part of the body so as to interfere with the respira- 
tion or circulation. Pressure on the waists of children must be espec- 
ially avoided, and all weight of clothes should be borne by the 
shoulders, being supported either by braces or by loose stays attached 
to shoulder bands. Garters to support stockings exercise an injurious 
influence on the circulation of the legs ; stockings ought to be sup- 
ported by elastic suspenders, attached at their upper end to stays 
supported from the shoulders, or to a very loose waist-belt. 

The same principles which have been mentioned in reference to the 
clothing of children are equally applicable to the dress of later youth. 
In girls merino combinations should be worn during the day through- 
out the period of puberty, an age at which any insufficiency of clothing 
is apt to have specially prejudicial results. Flannel or merino should 
also be employed for the night-dress. In boys, during the day, merino 
jerseys and pants may be substituted for combinations ; and for clothing 
during the night by far the most eligible is the costume so universally 
used in the East by Europeans, consisting of thin flannel pajamas and 
light flannel coat. 

Some attention should be given to the boots and shoes worn by 
children after they commence to walk. If their feet are to develop 
well, it is important that they should not be compressed in any direc- 
tion by their coverings. Many bootmakers invariably measure the feet 
when suspeuded in the air, overlooking the fact that when the foot is 
pressed on the ground it expands considerably in width. The result is 
that the boot is made too narrow in the sole, and the foot is compressed 
laterally, and consequently loses much of its elasticity. A boot or shoe 
should always be made wide enough in the sole to allow the foot to 
expand to its full extent without incurring any lateral compression. If 
this is not attended to, not only do corns develop, but the toes become 
compressed and crowded, and a bad style of walking is acquired. A 
similar result follows the wearing of inordinately high heels, which 
cause the foot to slip forwards within the boot, resulting in compres- 
sion and malformation of the toes. The interior of a boot or shoe 
should conform to the natural sole of the foot, and the surface for the 
heel should be on a level with the surface for the ball of the great toe. 
If this and the due breadth are attended to, it is a matter of small im- 
portance whether a shoe or boot is worn, or whether the boot be laced, 
buttoned, or spring-sided. When spring sides are used, however, care 
should be taken that the pressure is not great, and that it is equally 
distributed over the foot, not concentrated in a ring round the ankle. 

[How to Dress the Baby. — In a pamphlet with this title Mrs. 
Susan T. Converse has criticised the usual mode of dressing a baby, 
and suggested what she regards sis a far better plan. Instead of merely, 



132 



GENERAL CAKE OF THE CHILD. 



referring the reader to this pamphlet (issued at ten cents by the Murray 
Hill Publishing Co.), the practical part of it is presented here, with the 

Fig. 21. Fig. 22. 




FRONT VIEW OF PRIMA ALFHA. 



It should be explained at the outset 
that the cut represents the band "b " 
"b" as located too high on the body of 
the child. 

'* a" is body of shirt ; , 'b"'"b'" is 
band worn around body of child ; " d " 
"d" diaper; li c" diaper shield, the 
front end fastened on band by two but- 
tons ; ll f" "f" legs of drawers fast- 
ened on band on each side where the 
buttons are observed, and adjustable 
to growth of child by lowering buttons 
as desired. The points where socks are 
attached to legs of drawers by nursery 
pins to prevent being kicked off by 
activity of little feet, may be seen just 
above the ankles. 




BACK VIEW OF "FRIMA ALPHA." 

In this, as in the companion picture, 
the cut represents the band li b" *'b" 
as located too high on the body of the 
child. 

"a ,! is body of shirt: "b' 1 "b" 
is band, worn around body of child ; 
"d" "d" diaper; " c ' " diaper shield, 
fastened on band by two buttons, so 
located as to prevent pressure on spine 
or parts unprotected by bony structure ; 
:t f " "f" legs of drawers, fastened on 
band by button on each side, a little 
above the letters " f " and adjustable 
to growth of child by lowering buttons 
as required. The points where socks 
are attached to legs of drawers are 
observed a little above the ankles. 



illustrations. The lady had been for many years in the business of 
making undergarments for all ages and both sexes, and what she offers 
seems wnrrliy of consideration here. 



HOW TO DRESS THE BABY. 



133 



"At birth, an infant in aormal condition will assert its right to be 
free by extending its limbs and by cries that fill its lungs with air. 

"But, alas! awaiting its coming are numerous tortures called ' cloth- 
ing,' and human hands ready to apply them to the tender little body, 
Where there is no special thought, intelligence, or care in adjustments 
injuries are begotten which, in numberless cases, are lifelong in results. 

"The inevitable band is closely pinned around the bowels, subject- 
ing internal organs to compression, that is, doubtless, severely uncom- 
fortable for the child. How far this process is accountable for so many 
many deaths of newly born babies we will not here declare. But, it is 
a feature in dressing that receives far less consideration than its serious- 
ness demands. 

"Next, the little shirt is called forth from the daintily supplied 
'basket.' 

"This needful garment of baby's wardrobe has undoubtedly been 
the subject of earnest endeavor in right directions, for it is now 'the 
fashion ' to have it made of elastic, knitted fabric, covering neck and 
arms of infant with equal warmth. Next called for is the diaper, 
which, as the habit applies it, is the cause of discomfort, disease and 
the ruin of many a valuable life. This declaration may seem monstrous 
and indelicately paraded. For a moment, consider the matter. 

" It is pinned around the loins of the newly born babe in a manner 
so close that it will not ' bother ' the nurse or mother by slipping off. 
To keep it in place it is generally so folded and applied that it prevents 
the natural action of the lower limbs which a baby would involuntarily 
indulge in if freed from fetterings. 

" Then comes the long flannel 'petticoat' or 'slip' made for the 
express purpose of hampering movements of the legs and feet as well as 
wrapping for warmth. Over this is worn the dress of muslin or other 
cotton fabric anywhere from 1^ to 1^ yards in length. 

"When thus fully dressed, the draperies are carefully tucked 
around the tiny limbs that would move freely if permitted to do so — thus 
balancing the circulation of the blood in the newly born being. 

"Baby is placed in the bed, and there again tucked about with ten- 
derness and care. 

" Now what chance has the little body for motion ? Or, if taken into 
the arms of an adult, think of the drag upon the cartilaginous frame, 
upon the delicate abdominal structure occasioned by all the weight of 
' dry goods ' fastened, by close pinnings, around the little body. The 
long skirts flap and cling as baby is lifted or perhaps unwisely tossed 
by the attendant, and slipping out of place for band, diaper, and skirt is 
inevitable. 

"Baby has no way of expressing the suffering such weights, drag- 
gings, displacements, and fetterings occasion, except by cries that are 



I3«i GENERAL CARE OF THE CHILD. 

too often interpreted as calls for decoctions, trottings, pattings of tender 
3pine, etc.. that are, if possible, more mischievous in results. In general, 
the beginning of infant life is the duplicate of this recital. 

" Out from such discomforts and deformities that often arise from 
these causes in infancy, there are many maimed ones whose existence 
is a burden to themselves and the world ; afflicted ones are not always 
found in homes where a paucity of means and lack of culture wooed 
and won the sorrow. 

" How Can the Trend to Evil be Corrected ?— First.— By com- 
mon sense displacing ' fashion ' and substituting greatly shortened skirts 
for flannels and dress, so there shall be entire freedom for the child's 
limbs 'to play,' as they surely will, if not fettered by useless lengths 
and draperies. 

" Second. — Let the band, needful for clasping around the body at 
birth, be attached to the shirt, so that the slipping out of proper place 
may be prevented. 

"Third. — To the back of the band attach a shield for the diaper. 
The shield, placed under the body of the child, outside the diaper and 
confined at the end on the front of band by means of buttons or safety- 
pins. When thus arranged and supported the shield bears the weight 
of the diaper and prevents its slipping down or off, thereby precluding 
the necessity for girding, too tightly, the loins of the infant. 

"Fourth. — And specially important it is, to cover the legs warmly 
with drawers which will keep the blood flowing healthfully and not re- 
strict activity. Upon the little feet put warm socks, attach them to 
the legs of drawers, and when thus dressed and wisely managed baby 
will enjoy his ' right to be well born.' 

" Drawers Upon a Newly Born Baby ! — More than one woman 
has thus contemptuously exclaimed. But, we say, try them for once. 
Only little legs, of proper length and size, for the first dressings of 
some warm, flexible material, extending three or four inches beyond 
the little pink toes, keeping them warm, and serving as * socks ' or 
coverings for the feet; if greater nicety of fit is desired, extending 
only to the top of foot of baby, and then the warm, knitted sock put on 
and fastened over bottom of drawers legs. The sock is confined by a 
nursery pin, to the braid upon the side of the drawers' ankle, for ser- 
ving that purpose. The top of drawers' legs attached to waist-band, by 
two buttons on the sides, over the hips. 

"To make the full set of appliances costs more of time than for the 
manufacture of the ordinary style of infants' underwear. But, compare 
the benefits to the child with the sufferings occasioned by the usual 
methods, where large sums are spent for trimmings for adornment."] 



\F' 




FIRST STEPS. 



xi. 0:nmxfien. 



CHAPTER XIII. 



Thb Nittkition op the Child. 

Mother's Milk the Natural Food; Temporary Substitute when Necessary* 
Difficulties of Sucking; Frequency; Amount of Milk obtained; Use of one 
or both Breasts; Indications of Discomfort from Excess of Milk taken; 
Progress of Natural Nursing; Insufficiency of Supply of Milk; Necessity of 
Artificial Supplement; Eligible Substitutes; Use of Feeding-bottle; Tem- 
perature of Artificial Food; Farinaceous Foods; Selection; Quantity to be 
given; Occasional Inability to digest diluted Cow's Milk; Alternatives; 
Milk Humanized ; Sterilized; Peptonized; Asses 1 Milk; Goats' Milk; Wet- 
nurse; Addition of Farinaceous Food; Feeding by Spoon; Addition of 
Animal Food; Objections to Nerve-stimulants; Common Errors in Diet of 
Infants; Deficiency of Fat; Excess of Farinaceous Food; Excess of Nitro- 
genous Food ; Irritability of Digestive Organs in Children. 

The natural food for a young infant is the milk secreted In 
the breasts of its mother. This secretion is generally present in small 
quantity at the time of the birth of the child, but is not usually found 
in abundance until a day or two after that event. During the first one 
or two days of its life the baby may thus appear to have an insufficient 
supply of milk ; in some cases, indeed, the supply may be entirely 
absent for some time after birth, not appearing until the fulness and 
distention of the breasts described in Chapter X. have developed on 
the second or third day after parturition. However little milk there 
may appear to be in the breasts immediately after the birth of the 
infant, it is always well that it should be induced to avail itself of what 
is present. The early secretion of the breasts after confinement has a 
peculiar purgative action on the child, which promotes the discharge of 
the contents of the bowel known as meconium, and prepares the alimen- 
tary canal for the due digestion of the normal milk which succeeds in 
due time the first secretion. The sucking action of the infant also 
acts as a stimulus to the lacteal glands of the mother, while, at the 
same time, her nipples are drawn out and made more easily available 
for the future demands of the child. Unless an infant is very wakeful 
and fretful during the first one or two days of life, it is not desirable, 
and certainly it is not necessary, to give it any food beyond what it is 
able to extract from its mother's breasts. There is not the slightest 
risk of the baby suffering in any way from starvation, even if it has to 

135 



I3 6 THE NUTRITION OF THE CHILD. 

wait two or three days for an ample secretion of milk ; and it will 
digest and utilize its mother's milk to greater advantage when the flow 
does come, if its stomach has not been irritated in any way by the 
administration of artificial food in the interval of waiting. 

Temporary Substitute. — When, however, fretfulness, wakeful- 
ness, and apparent hunger, indicated by ravenous suction at the 
breasts, indicate the propriety of temporarily satisfying the wants of the 
child, the most appropriate food is cow's milk diluted with water to 
the extent of double the quantity of the milk, and slightly sweetened 
with white sugar, or sugar of milk. This should be administered 
either by means of a spoon or from a bottle, and should be given in 
quantities of not more than two tablespoonfuls (one fluid ounce) at a 
time, and not more frequently than every two hours. As soon as there 
are indications that the breasts are secreting satisfactorily, the artificial 
feeding should cease at once. These indications will be found in the 
fulness and hardness of the breasts, in the discharge of milk from the 
nipples, and in the facility with which slight pressure on the breasts 
will cause a flow from the nipple. 

Difficulties of Sucking — Considerable difficulty is sometimes ex- 
perienced in inducing the baby to suck the breasts properly, more 
especially when the milk is rather difficult to extract, or when it has 
been fed artificially for two or three days from a bottle, from which it 
is considerably easier to extract the milk than from its mother's breast. 
Breasts vary considerably both in the form of the nipple and in the 
facility with which the milk flows from the ducts, even when the quan- 
tity may be plentiful. The baby must in cases of difficulty be induced 
to suck properly and strongly, in the first place by the stimulus of 
hunger, and in the second place, when necessitated by the want of 
projection of the nipple, by the assistance of artificial nipples, and by 
the pressure of the hand of the mother or nurse upon the breast. In 
Chapter X. a description has been given of the kind of artificial nipple 
which should be used for this purpose, together with directions for its 
employment. In all cases where undue difficulty presents itself in 
sucking, and where this difficulty is not apparently owing to any defi- 
ciency in the supply of milk, or any want of projection or malforma- 
tion of the nipple, a careful examination should be made of the mouth 
and tongue and nose of the infant. Children are occasionally born with 
a perforation in the roof of the mouth communicating with the nose, 
and when this is present suction becomes impossible without some arti- 
ficial aid. It is very seldom indeed that the abnormal connection of 
the under side of the tongue with the floor of the mouth, known as 
"tongue-tying," exists to such an extent as to limit very materially the 
capacity for suction ; but when other difficulties are present, it may 
add to them, and accordingly call for remedy by a slight and unim- 



FREQUENCY OF SUCKLING. I 37 

portant incision. Catarrh of the nose interferes very seriously with the 
power of sucking strongly, and when present may call for a consider- 
able amount of attention. It is only after exhausting all possible 
sources of difficulty that one is entitled to assume that the infant has a 
dislike to the milk of the mother, and must be humored by being fed 
in some artificial manner. 

Frequency of Suckling. — A recently born infant usually requires 
nursing at intervals of about two hours during the day, and of about 
three hours during the night. This will give an average of nine or ten 
administrations of food in the twenty-four hours. At each of those 
times it will probably receive from one to two fluid ounces of milk, 
which will amount to between half a pint and a pint in a whole day 
and night. Experiment and observation have shown that the average 
capacity of an infant's stomach at birth is about one fluid ounce, but, 
being elastic, the stomach is capable of some distention beyond this ; 
and when the supply of milk is abundant, strong babies almost invari- 
ably exhaust from the breast somewhat more than they can comforta- 
bly digest and absorb. The secretion of milk by the breast of the 
mother varies somewhat with the frequency with which it is exhausted ; 
on an average, it usually amounts to quite a pint in the twenty-four 
hours, and may attain to double that amount. When excessive calls 
are made on the breasts, however, either by the voracity of one strong 
infant, or by the attempt to suckle two together, the milk is apt. to 
degenerate considerably in quality. 

When the supply of milk is good, it is usually sufficient to give 
only one breast to the young infant at each time of nursing ; and by 
alternating the breasts at successive meals a longer period of rest 
is given to the nipple, and a somewhat less tax is imposed on the 
health of the mother. On this point also reference maybe made to 
Chapter X. 

Difficulties of Digestion. — When the baby has taken more milk 
than it can comfortably accommodate, it shows immediately after the 
nursing is completed signs of uneasiness and fretfulness. These may 
be accompanied by slight eructations of wind, and are generally fol- 
lowed by vomiting of the excess of milk, after which rest and comfort 
ensue. In young infants the act of vomiting is not in any degree the 
painful process which it invariably is when occurring in adults. 
Rather is it a gentle emptying of superfluous contents without any un- 
comfortable exertion, and without any subsequent depression. The 
sensation of nausea appears not to affect babies ; before the stomach is 
relieved they seem to have no discomfort beyond the sense of distention, 
and after the relief from partial evacuation of the contents, they are 
usually perfectly happy, and settle down to the digestion of what 

remains with a sense of placid well-being. 
r>a 



1 38 THE NUTRITION OP THE CHILD. 

When sickness in babies is due only to an overcharged stomach, 
the milk vomited has a perfectly fresh odor, and is little if at all 
curdled. When the cause of the sickness, on the other hand, is irrita- 
bility of the stomach, or some change in the quality of the milk, mak- 
ing it more difficult of digestion, the vomiting usually occurs some 
time after the ingestion of the food, and the vomited matter has a sour, 
unpleasant smell, and is usually markedly curdled. When this is 
noticed, attention must be directed to the general health of the mother, 
and to the possibility of her having taken any food or medicine likely 
to prove injurious to the quality of the milk. In the vast majority of 
cases of irritability of digestion in young infants nursed exclusively by 
their mothers, some local or general cause affecting the condition of 
the milk will be discovered. In some cases it may be traced to some 
unwonted food partaken of by the mother ; in others to some local 
irritable condition of the breast ; and in others, again, to general dis- 
order of the mother's health, such as results from a feverish attack, or 
from the recommencement of the menstrual flow. Whatever the cause 
may be found to be, treatment must be directed to remove it. It is 
useless and absurd to direct treatment to the digestion of the baby so 
long as the cause persists which has initiated the disorder, and contin- 
ues to aggravate it, 

Another important indication of the suitability of the milk to the 
infant is found in the character of the motions passed from the bowel. 
When the digestion is healthy, even though the stomach be occasion- 
ally overcharged with food, the motions will be observed uniform in 
character and consistency, and of a healthy yellow color. When the 
digestion is impaired, and the digestive canal irritated, the. motions will 
usually become of a pale color, undigested curdled masses of milk will 
be found mixed with the usual fecal matter, and often a considerable 
(quantity of greenish gelatinous matter, known as mucus, will be mixed 
with the motion. If the irritation be considerable, the motion may not 
i infrequently be seen to consist almost entirely of this greenish mucus, 
with which occasionally will be mixed fragments of curdled milk. 
When the motions become thus unhealthy and abnormal in character, 
they form conclusive evidence of some disorder of digestion, and atten- 
tion should be at once directed to discover and eliminate the cause of 
the derangement. 

Gradual Decrease in Frequency. — When the baby attains the 
age of two to three months, the intervals between the periods of nur- 
sing should be somewhat lengthened, more especially at night. At this 
age an infant should not generally be given the breast oftener than 
every two and a half hours during the day, and may even wait for 
three hours, while, during the night, an interval of between three and 
four hours between the periods of nursing may be attained. The 



LACK OF BREAST MILK. 



139 



capacity of the stomach has now considerably increased, and the infant 
is able to retain from twice to three times as much milk as it could do 
immediately after birth. In the case of children of normal strength, it 
is always well to make the intervals between the periods of nursing as 
long as possible. The infant in this way manages to complete thor- 
oughly the digestion of one meal before commencing another, and the 
risk of irritation is very much diminished, while the mother escapes 
harassing frequency of nursing, and is not exhausted so much by her 
maternal duties. More especially should the night intervals be length- 
ened to the utmost extent, in order to allow the mother as much undis- 
turbed sleep as possible. 

At the age of five to six months many babies will allow of an interval 
of fully three hours during the day, while at night they will be satis- 
fied by being nursed when the mother retires to rest, and once again 
between five and six in the morning. At this stage a baby who is 
being exclusively nursed by its mother will probably remain until 
weaned. 

Insufficiency of Supply of ililk. — Not unfrequently it happens 
that while the breasts of the mother secrete a certain quantity of milk 
after confinement, this is not sufficient to satisfy the wants of the infant. 
It may be observed that the baby continues to suck after all the milk 
has been exhausted, or, finding the supply at an end, it may leave off 
hungry and dissatisfied, and desirous of more food after a very short 
interval. It will usually be remarked in such cases that the baby does 
not progress with normal rapidity, and if the breasts of the mother be 
examined immediately before nursing, they will be found wanting in 
the fulness and tension of breasts which are duly charged with milk. 
When this condition occurs, it is necessary at once to supplement the 
mother's milk by some artificial food. Suckling by the mother should 
not be stopped entirely if the milk agrees with the child, and is don* 
cient only in quantity, but a longer interval between the acts of nur- 
sing must be allowed to admit of the breasts becoming more full, and 
in the intervals between the periods of nursing some substitute for the 
mother's milk must be provided. 

Fresh Cow's flilk, diluted with two or three times its bulk of 
water, and slightly sweetened, will be found, as a rule, the most satis- 
factory substitute for the mother's milk, when arrangements can be 
made to obtain a regular supply two or three times daily of fresh 
milk from the same cow, and reliance can be placed on its purity. It 
is found generally that when fresh cow's milk is employed as the food 
of young infants, it is more easily digested if the milk be always ob- 
tained from the same cow, the stomachs of infants being sensitive 
to minute alterations in the character of the milk wnich cannot be 
discovered by any process of examination or analysis. An infant's 



T 4 o THE NUTRITION OF THE CHILD. 

stomach will also detect slight sourness in the milk long before it 
becomes apparent to the taste or other senses of the adult, and will 
resent the sourness by ejecting the milk, so that it is most important, 
more especially in summer, that the cow's milk should be obtained 
fresh two or three times a day. Milk, if boiled when fresh, does not 
turn sour so quickly as unboiled milk, and the freshness can be main 
tained also for some time by the addition of a small quantity of bicar- 
bonate of soda to the new milk, about ten grains of bicarbonate of soda 
(as much as can be heaped on a dime) being used for a pint of milk. 

These methods of keeping milk fresh are not, however, perfectly 
satisfactory, as the boiling somewhat alters the character of the milk 
and makes it a little more difficult of digestion, while the quantity of 
bicarbonate of soda used, if its employment is continued for a time, 
may weaken to some extent the digestion of the infant. 

Condensed Cow's Milk. — When difficulty is experienced in ob- 
taining fresh milk for the diet of the child, it is better to resort to the 
use of condensed milk, and if one particular brand be adhered to, the 
milk is usually so uniform in character that the infant's stomach dis- 
covers no difference in quality in the successive tins opened. Con- 
densed milk is simply cow's milk which has been for some time exposed 
to a temperature equal to that of boiling water, for the purpose in the 
first place of destroying any germs which may give rise to decomposi- 
tion, and in the second place of concentrating its strength by evapora- 
ting the water in it ; and which has then been enclosed in air-tight 
tins. In some brands a certain amount of sugar is added to facilitate 
the preservation ; in others this is omitted, and the milk is sold under 
the name of "unsweetened" condensed milk. Generally speaking, the 
unsweetened is now preferred to that with sugar added ; but both 
seem to agree equally well with many babies ; and perhaps the only 
advantage which the unsweetened has over the sweetened is, that it 
keeps fresh after the air-tight tin has been opened for a somewhat 
longer period. The difficulty of keeping the milk fresh after a tin has 
been opened is the main drawback to the use of condensed milk. 
Otherwise it is a very eligible food for infants, as decomposition is ob- 
viated by the exposure to heat, while its digestibility has not been 
impaired by boiling. It would be of much advantage if it were put up 
in much smaller tins than it is usually stored in, so that a fresh tin 
might be opened at least once every day. In diluting fresh cow's milk 
or condensed milk, water which has been boiled should always be em- 
ployed, and the addition of a little sugar of milk may be necessary to 
induce the baby to take it readily, as cow's milk diluted to the extent 
mentioned above is not nearly so sweet as the milk of the mother. 

Necessity for Dilution. — Cow's milk, whether fresh or con- 
densed, is not so easily digested as mother's milk. When the 



FIXING COW'S MILK FOR INFANTS. 



141 



digestion of mother's milk commences in the stomach, it is altered into 
small soft particles of curd, which are easily permeated by the gastric 
juice, and reduced again to a uniform solution capable of being 
absorbed by the walls of the stomach and intestines. Cow's milk, on 
the other hand, curdles in the stomach into somewhat hard and large 
masses, which resist the action of the gastric juice, and are apt occa- 
sionally to irritate the walls of the stomach and produce pain. The 
object of the dilution which has been recommended is mainly to pre- 
vent this curdling, or at least to reduce the size of the masses of curd, 
and diminish their hardness so far as to allow of the gastric juice exer- 
cising satisfactorily upon them its digestive influence. To chemical 
analysis the milk of cows is not very much richer than human milk, and 
very little dilution would be required to render it acceptable to babies 
if it were not for its tendency to coagulate in hard masses. The pre- 
vention of this is even more effectively carried out if thin barley-water 
is used for dilution in place of simple boiled water. Barley-water em- 
ployed for this purpose should be made from ordinary pearl barley, 
about a full teaspoonful of which should be washed, and then boiled 
for twenty minutes in a pint of water. When this has been strained 
and allowed to cool it is ready for mixing with the milk. Barley-water 
does not keep long without deterioration ; a fresh supply should there- 
fore be made daily. 

Cow's milk is usually somewhat more acid than human milk, and 
when indications are given, by the infant vomiting milk with a very 
acid smell soon after drinking the diluted cow's milk, that the acidity is 
creating irritation, it should be neutralized by the addition of some 
lime-water or a little bicarbonate of soda. If lime-water is used, 
it should replace one-half of the water or barley-water employed to 
mix with the milk ; if bicarbonate of soda is preferred, about as 
much as will lie on a threepenny bit [or half dime] may be added to 
each meal. Lime-water should usually be preferred when there is a 
tendency to relaxation of the bowels ; bicarbonate of soda when the 
baby inclines to constipation. 

Condensed milk does not usually curdle in such hard or large 
masses as fresh cow's milk, and accordingly does not require to be 
diluted to a proportionate extent ; but it must be remembered it requires 
the addition of a considerable amount of water to replace what has been 
evaporated in the preparation, so as to restore it to the condition of un- 
diluted fresh milk. This replacing dilution is generally stated on the 
outside of the tins in which the milk is stored ; it differs a good deal 
in different brands of condensed milk. As a rule, condensed milk, like 
fresh cow's milk, will be found to digest better when diluted with barley- 
water than with plain boiled water ; in using it the addition of an alkali, 
either lime-water or bicarbonate of soda, may be necessary. 



1 42 THE NUTRITION OF THE CHILD. 

Feeding Bottles. — When artificial food is given to young infants, 
it ought to be administered through a proper feeding-bottle, from which 
the baby can suck the milk, just as it does from its mother's breast. 
Bottles are made of various designs by different makers, and their 
merits are urged on various grounds. By far the most important qual- 
ity of an infant's feeding-bottle is, that it should be of such shape and 
construction as to admit of thorough cleanliness. All other charac 
teristics of bottles are simply questions of convenience ; cleanliness is a 
matter of vital importance. 

Generally speaking, the simpler the construction of a bottle, the 
more easy it is to keep it thoroughly clean. The ideal bottle is one made 
entirely of glass, except the nipple, which should be of india-rubber, 
easily detached from the bottle, and easily replaced. There should be 
no corners in it, and a simple opening at one part to allow the milk to 
be poured in, closed with a glass stopper, with a groove in it, which 
should be able to be turned so as to admit a little air as the baby ex- 
hausts the milk. India-rubber tubing, connecting the bottle with the 
nipple, should not be made use of. It is exceedingly difficult to keep per- 
fectly clean, and as the inside of it cannot be thoroughly inspected, it 
is impossible to be satisfied of its absolute freedom from impure matter. 
It also affords undesirable opportunities for the mother or nurse neglect- 
ing the infant during the process of feeding, as with the tubing the 
bottle may be placed in any position while the baby exhausts it through 
the tube. In such an important matter as feeding a baby, individual 
attention should be given by the nurse or mother to the process, and 
the bottle should be held in the hand of the administrator until the in- 
fant has satisfied its wants. The bottle should then be washed out as 
soon as possible with hot water, the india-rubber nipple having been 
first removed, and should be left lying in clean water until again re- 
quired. When necessary, a little soda may be added to the hot water 
used for washing the bottle, if there is any difficulty in making it thor 
oughly clean. The india-rubber nipple should be washed carefully with 
cold water in which a little boracic acid has been dissolved ; about a tea- 
spoonful of boracic acid to half a pint of water makes a convenient solu- 
tion for this purpose. After being washed carefully, the nipple may 
be replaced on the bottle. In order to obviate any possibility of the 
baby sucking the nipple off the bottle and swallowing it, it is usual to 
surround it with a flat ivory collar, which rests against the outside of 
the lips when the baby is being fed, and prevents the nipple from being 
drawn too far into the mouth. 

Temperature of Artificial Food. — Artificial food given to young 
infants shotild always be warmed to a temperature approaching that 
of the body. It is best to ascertain this by the use of a clinical ther- 
mometer, such as is described in Chapter XVI., the temperature of the 



FARINACEOUS FOODS. I4 3 

food being regulated by its use so as not to exceed 98° F., and not to fall 
below 90° F. Many nurses judge of the temperature of the food by 
tasting it, and a careful nurse is not likely*to make any mistake if she 
takes this precaution before administering the food, but the application 
of the thermometer is so simple and occupies so little time that it is 
always best to make use of it in preparing the meals of very young in- 
fants. Bottles have recently been introduced fitted with thermometers 
for this purpose ; they are convenient in use, but liable to breakage. 

DuriDg the first six months of life it is best not to use any food 
except the preparations of milk already described, or the others to be 
mentioned later, in supplement of the milk of the mother. After this 
age, if the baby is making satisfactory progress, a little farinaceous 
food of some kind may be given. 

Farinaceous Foods may be classified under three heads : those 
which have not been subjected to any special preparation, those which 
have been already partially cooked, and those that have been malted, 
or partially predigested in some other manner. Of the first the most 
commonly used are fine oatmeal, barley, hominy, corn-flour and arrow- 
root. Of the prepared foods the number is now so great that it is 
impossible to attempt an exhaustive list. 

[Dr. Westland names a few of the favorite proprietary foods used 
in England, but most of them are not to be had in all parts of the 
United States, and as this edition is intended for wide circulation, it 
may be as well not to make mention of any. It is almost superfluous 
to remark that we have enough of our own in the great variety of 
specially prepared " infants' foods," each of which is loudly proclaimed 
as " the best " by its manufacturer. Every maker is able to exhibit in 
his circulars and advertisements a number of testimonials from mothers 
and physicians which seem to prove the acceptability and utility of 
these products ; and we incline to give them all credit for an honest 
effort to provide a generally reliable form of artificial or substitute 
food for infants. Many physicians may have found reason for pre- 
fering one to another, and when any food is prescribed the mother may 
do well to follow master, and place the responsibility for results on the 
doctor who is advising her. No doubt some of these prepared foods 
are well adapted to some infants and not to others. There are babies 
that find their own mother's milk incompatible, and some artificial 
food may do better. It is not surprising that with infants as with 
adults a variety of foods is necessary to suit all wants ; but, if we read 
aright the signs of the times, and the drift of professional views on 
infant feeding, there is an increasing disposition to set aside the manu- 
factured substitutes, and to find what every suckling babe requires in 
some combination of what is now prescribed as "modified rn.Uk," 
which is in fact a sterilised milk made to order. 



144 



THE NUTRITION OF THE CHILD. 



In the larger cities there are laboratories where cow's milk is 
treated in a way to free it from all uncleanness and germs, separate its 
elements, and recombine them in definite proportions, so that a pre- 
scription can be written for an infant's daily food that may fit it better 
than the mother's breast milk, and which can be varied from week to 
week as the child grows. Thus each infant's day's rations is delivered 
daily in six or eight portions, each feeding in one tube, and all in one 
neat box or basket which should be kept in a refrigerator. Each tube 
is, just before feeding, warmed to proper temperature, gauged by a 
thermometer, and as the size of the tube is fixed according to the 
infant's age, it is presumable that the child gets just the right kind of 
food, in right amount, at right temperature, and at proper intervals. 
This is the latest scientific fashion in the attempt to arrange for an 
accurate, safe, and satisfactory substitute for nature's font, where for 
any reason that is not available or satisfactory. Apparatus has also 
been devised by which this plan of modifying milk, or making over 
cow's milk into an exact substitute for mother's milk, can be managed 
" at home " by mothers who have no access to the special laboratories 
already mentioned. It is not too elaborate or expensive for the average 
mother, and not beyond the intelligent understanding of those who 
would read thus far in this book ; but, outside of cities, and especially 
where the milk-supply is near at hand, good at the source and not 
subject to the changes of transportation and of time, the simple 
addition of pure water and cream in right proportions (and sometimes 
of barley-water or lime-water) will suffice in place of a more painstaking 
modification. As cow's milk may be acid, and as infants require an 
alkaline food solution, it is customary to use lime-water to correct this 
fault of cow's milk, but lime is so little soluble in water that enough 
cannot be dissolved to make an over-dose. One spoonful of lime-water 
to sixteen of milk will suffice.] 

The Bringing=up of an Infant " by Hand." — Speaking general- 
ly it is only during the first six months of an infant's life that much 
difficulty presents itself in the selection and management of food, and 
having brought the baby, entirely or partially nursed by its mother, to 
this point, a convenient opportunity presents itself of reverting to the 
commencement of life, and considering the diet appropriate to infants 
who, for various reasons, are unable to enjoy the comfort and advan- 
tage of maternal nutrition. 

"When it has been decided that a baby is to be brought up on arti- 
ficial food, or "by hand," as it is sometimes teclmicall}- called, it is 
usual to commence with the administration of diluted cow's milk, which 
may be either fresh or condensed. Whichever of the two is selected — 
and the selection must be made on grounds already laid down at p. 
139 — should be diluted with boiled water or with barlev-water, in the 



BOTTLE-FEEDING. 145 

proportion already described as suitable for new-born infants as an 
addition to the mother's milk, and, slightly sweetened with sugar of 
milk, should be administered through a bottle about every two hours, 
in quantities suited to the capacity of the stomach. Immediately after 
birth from one to two fluid ounces — a fluid ounce containing about two 
tablespoonfuls — is a proper quantity ; when the baby is a month old 
about three ounces may be given, and this may be increased to about 
four ounces when the age of two months has been attained. At three 
months of age about five ounces of food will usually be taken at a meal 
with comfort, and before the age of six months is reached a baby may 
not be satisfied with less than six to eight ounces at a time. 

Usually a baby fed on cow's milk from the bottle will require food 
rather more frequently than one nursed by its mother, but it is always 
well to lengthen the intervals as much as the child will permit. The 
amount of dilution necessary to aid the digestion of the cow's milk 
diminishes the nutritive value in proportion to the quantity. A baby 
nursed ten times in the twenty-four hours, and obtaining an ounce and 
a half of milk from the breast at each period of nursing, would receive 
in the course of the day and night fifteen ounces of pure milk. On the 
other hand, a baby fed by hand, and receiving two ounces of a dilution 
of one-third of milk to two-thirds of water every two hours, would 
only obtain eight ounces of pure cow's milk in the twenty-four hours, 
the other sixteen ounces being water or barley-water, of comparatively 
little nutritious value. It is true that undiluted cow's milk is some- 
what richer than mother's milk, but not so much so as to make eight 
ounces of the one equivalent to fifteen ounces of the other. Babies, 
however, do progress quite satisfactorily upon an allowance of from 
eight to ten ounces of pure cow's milk daily, so that it is probable that 
the estimate of the mother's milk, as amounting to fifteen ounces daily 
immediately after confinement, may be somewhat overstated. 

When the baby has reached the age of six weeks, the amount of dilu- 
tion of the milk may be somewhat lessened ; and at three months most 
infants will take easily cow's milk diluted with an equal quantity of 
water or barley-water. At this age a healthy babj- will allow of inter- 
vals of at least three hours between its meals, and calculating that it 
has seven meals in the twenty-four hours, and takes at each meal five 
ounces of diluted milk, it will receive not much less than a pint of pure 
milk during the day and night. The remarks about dilution apply 
equally to fresh milk and condensed milk, it being remembered always 
that the condensed milk requires an initial dilution to restore it to the 
condition of fresh milk. 

After the age of three months the capacity of the stomach in^ 
creases more slowly, so that the quantity of food given at a meal can 
be augmented only very gradually ; but the digestive power usually 



146 THE NUTRITION OF THE CHILD. 

increases rapidly, and it is possible to diminish the dilution of the milk 
so rapidly that at the age of five or six months, pure cow's milk may 
be given without any dilution. [At six months of age it is permissible 
to add home-made farinaceous food made from oats or barley, to be 
given only in solution and with milk. Oat jelly is made by soaking 
four ounces of oat-meal in a quart of cold water for twelve hours, and 
then boiling this down to a pint, which can be strained through a fine 
cloth while hot. As it cools, a jelly forms which is kept on ice till 
needed, when equal parts of the jelly can be warmed with cow's milk. 
Barley jelly can be made in the same way.] 

Occasional Inability of Infants to digest diluted Cow's ililk. — 
Not unfrequently it happens that the new-born infant is unable to 
digest cow's milk, however much it may be diluted with water or barley- 
water. What course is to be then adopted ? Two alternatives present 
themselves in this emergency. The first is to adopt some method of 
preparing the cow's milk so as to make it more easily digested than 
when simply diluted with water or barley water. The other is to resort 
to the use of some other kind of milk, either that of the ass, or of the 
goat, or of a wet nurse. 

The first alternative will in general be preferred as the more con- 
venient, and three different methods of preparing milk for infants' 
digestion are employed, which will be described in the order in which 
perhaps they are most frequently used. All, however, in varying cir- 
cumstances are equally eligible, and individual preferences will not un- 
frequently decide the selection. If one method is unsatisfactory in 
regard to the comfort and welfare of the child, another must be 
resorted to. 

The milk prepared by the three methods respectively is known as 
humanized milk, sterilized milk, or peptonized milk. 

Humanized milk is simply cow's milk diluted with a certain 
amount of whey, and with some superadded cream. It is prepared in 
the following way : A certain quantity of cow's milk, say, a pint, is 
set aside in a cool place until the cream rises to the surface. This is 
skimmed off and kept, and to the milk remaining is added enough 
essence of rennet to curdle it thoroughly. The whey is strained off 
from the curd, added with the cream previously separated to a pint of 
fresh cow's milk, and the mixture is known as humanized milk. It is 
distinctly more digestible than ordinary diluted milk, and often agrees 
well with young infants, being given without any further dilution in 
the quantities suitable to the age of the infant. 

Sterilized milk is milk in which all germs tending to decomposi- 
tion have been destroyed by exposure to a boiling heat for a short 
period of time. Fresh cow's milk always contains some impurities 
received from the atmosphere or from the vessels in which it is con- 



STERILIZED MILK. 



147 



tamed, however much care may have been taken to maintain absolute 
cleanliness. To an infant with good digestion these impurities do no 
harm, the digestive powers being sufficient to overcome their influence ; 
but when the digestion is feeble, unhealthy fermentation is frequently 
caused by them in the child's stomach, which becomes irritated and 
inflamed, and its powers further enfeebled, while at the same time the 
milk in the stomach is rendered by the fermentation still more indigesti- 
ble. The result to the child is sickness, with vomiting of acrid and 
sour-smelling curdled milk, followed frequently by diarrhoea of an 
offensive character, with rapid wasting of body and loss of strength. 
Chemical and microscopical analysis has demonstrated that this un- 
healthy fermentation is due to the presence of small germs introduced 
with the impurities, and it has been discovered that those germs can be 
destroyed by exposing the milk for thirty to forty minutes to a tem- 
perature equal to the boiling-point of water, and that when the germs 
are so destroyed the milk does not ferment or decompose. The process 
of destroying the germs is known as the sterilizing of the milk, and is 
carried out in the following way : An apparatus for the purpose is 
necessary, which consists essentially of one dozen to twenty feeding- 
bottles, each capable of containing from four to five fluid ounces of 
milk, india-rubber and glass stoppers for these bottles, a tin saucepan 
with lid to be used for boiling, and a frame for holding the bottles when 
placed in the water in the saucepan. Some india-rubber nipples to be 
fitted on to the bottles for the convenience of the baby accompany the 
apparatus, and various little arrangements to assist in cleanliness. 

The bottles are filled up to the neck with fresh cow's milk diluted 
with water or with barley-water to the extent desired, partially 
stoppered with india-rubber stoppers perforated through the centre, 
and placed, arranged in the frame, in the saucepan, which is filled 
with cold water until the bottles are almost entirely covered. The 
saucepan is covered and placed on the fire, and the water is raised to 
the boiling-point, and kept boiling for about five minutes. The lid of 
the saucepan is then taken off, and the perforated openings in the cen- 
tre of the india-rubber stoppers closed by the insertion of the glass 
stoppers, which should be dipped in the boiling water before being 
pushed into the india-rubber stoppers. The lid of the saucepan is then 
replaced, and the boiling continued for thirty five or forty minutes. 
The milk is by this subjection to boiling heat thoroughly sterilized, 
and the bottles are removed from the saucepan, and put aside until re- 
quired for the use of the infant. They should be kept in a moderately 
cool place. If this is done, it is said that the milk will keep perfectly 
fresh for three or four weeks. It is undesirable under ordinary cir- 
cumstances to make any experiment, in this direction, and it will 
generally be found satisfactory to sterilize only enough at a time to 



148 THE NUTRITION OF THE CHILD. 

serve for twenty-four hours. To feed the infant, one of the bottles is 
taken and placed for a few minutes in water as hot as the hand will 
bear comfortably, until the milk in it is properly warmed ; the india- 
rubber and glass stoppers are then removed, and an india-rubber nipple 
attached to the neck of the bottle, from which the baby draws directly 
the sterilized milk. A fresh bottle must always be open for each meal ; 
if anything is left in it after the baby is finished, it should be 
thrown out. 

It will be seen from the description given that when the apparatus 
has been obtained, the process of sterilizing the milk is very simple and 
easy. The one difficulty is found in maintaining in perfect cleanliness 
the bottles, stoppers, and nipples. Directions about cleaning generally 
accompany the apparatus, and much attention must be given to their 
fulfilment, as upon cleanliness depends the whole success of the 
sterilization. 

[Sterilized milk may be obtained ready-made in New York and 
some other cities, but that which has been so highly heated as to keep 
fresh for several weeks is found to have lost something of its digest- 
ibility and fitness for nutrition. "While the sterilizing process is em- 
ployed in the making of "modified milk," previously described, the 
temperature is not raised to the boiling-point, and the milk is not pre- 
served by high heat to keep very long without change. Raw milk is 
more digestible than boiled milk ; or, heat that kills out all ferments 
destroys at least one that is desirable,] 

Peptonized milk, the third substitute for ordinary diluted milk 
when difficulties of digestion present themselves in young infants, is as 
simple of preparation as sterilized milk, and has the advantage of not 
calling for any apparatus. It consists of milk which has been partially 
predigested by the addition of some preparation of digestive fermeEt. 
obtainable from most pharmacists. The milk should be diluted to 
some extent before being peptonized, but it is not usually necessary to 
dilute it to such an extent as has been recommended for ordinary cow's 
milk. Generally, even for an infant of two or three days old, the ad- 
dition of an equal quantity of water or barley-water will be sufficient ; 
and when a baby is two or three months old a dilution of two parts of 
milk with one of water will be digested with comfort. It is best to 
peptonize at one time only enough for one meal, although in emergency 
enough can be prepared to last for twenty-four hours. 

The milk, diluted to the extent desired, is placed in a bottle or jug, 
and the powder mixed with it. It is then allowed to stand in water as 
hot as can be borne by the hand for from ten minutes to twenty 
minutes, when the peptonization is complete. If a bottle has been 
used, it may be given to the baby at once without further preparation 
Jf a jug or other receptacle has been used, sufficient milk for one meal 



PEPTONIZED MILK. 



149 



is poured ir to a bottle and given to the infant immediately ; what 
remains must be put in a saucepan and boiled for four or five minutes 
to arrest the further progress of the peptonization. It may then be 
left in a cool place for twelve to twenty-four hours if necessary, and 
simply heated by being placed in warm water before being administered. 

The degree of peptonization, and the consequent assistance given 
to the digestive power of the infant, depend upon the length of time 
the milk is subjected to the influence of the powder, the peptonizing 
process continuing until arrested by boiling. Generally it will be 
found that peptonizing for ten minutes or a quarter of an hour gives 
sufficient aid to the weakened digestion of the child. If the process is 
allowed to go on for much more than twenty minutes, or if too much 
of the peptonizing agent is used, the milk becomes bitter in taste, and 
somewhat curdled, and the infant may dislike and refuse to take it. 

When the peptonized milk is to be kept, the boiling, to arrest the 
fermentation, must be continued for about five minutes ; it is not suf- 
ficient simply to raise the milk to the boiling-point. 

A minute comparison of the merits of the different preparations 
would be out of place here, but it may be remarked that whereas the 
humanized milk is most suitable for babies of good health who have 
some difficulty or discomfort in digesting ordinary diluted milk, the 
other two preparations will be found of much value when there is 
special feebleness of digestion, whether or not accompanied by actual 
irritation of the stomach and bowels. Since their introduction, the 
use of the milk of other animals in place of cow's milk is resorted to 
much less frequently, and accordingly very little will require to be 
said with reference to the milk of the ass or the goat, although a little 
attention must be directed to the employment in certain cases of the 
services of a wet-nurse. 

[In a large and very recent work by Dr. T. M. Rotch of Harvard 
University, on the "Hygienic and Medical Treatment of Children," he 
thus writes of peptonized milk : "In many cases the indigestion is 
attributed to a lack of power to digest proteids (nitrogenous foods) at 
all, while in fact the stomach is simply rebelling against an excess of 
them. It would seem that, for the average infant, this predigestion is 
contrary to Nature's teachings. There are certain natural functions 
which should be allowed to act as they do on human milk, and it seems 
irrational not to encourage all the functions to act naturally, instead of 
forestalling their action and allowing them to fall into disuse and thus 
be weakened. So far as I know, no very brilliant results have been 
obtained from its use, except where the infant's digestion has been in 
an abnormal condition."] 

Ass's milk approaches in character and composition human milk 
more nearly than that of any other domestic animal. It is not quite so 



150 



THE NUTRITION OF THE CHILD. 



rich in cream as human milk, but resembles it very closely in its other 
constituents and in its general appearance, and, when easily obtainable, 
is a very valuable substitute for it. It can generally be taken by very 
young infants without dilution, only requiring to be warmed to the 
proper temperature. Unfortunately, as a rule, it is not easily obtained, 
and the price is apt to be somewhat prohibitive. 

Goat's milk is not very frequently employed in England as a 
substitute for human milk. It is a little richer, and requires some dilu- 
tion, although not so much as cow's milk, and it is certainly somewhat 
more easily digested than ordinary diluted cow's milk. 

The Wet «= Nurse. — Notwithstanding the value of these various sub- 
stitutes for the natural food of an infant, instances occur not very un- 
frequently where it is proper to avail one's self of the services of a 
healthy wet-nurse. Some infants are intolerant of all kinds of artificial 
food, and life itself may depend upon obtaining a wet-nurse ; in other 
cases some special weakness of the infant, such as results from prema- 
ture birth, or some constitutional peculiarity of the mother, may dictate 
the prudence of utilizing a wet-nurse, with a view to the future health 
and well-being of the child. The propriety of this will always fall to 
be decided by the medical attendant, who will give his advice on the 
selection of the wet-nurse. A mother must, in such a case, be prepared 
to overcome her reluctance to have her baby nursed by another woman. 
The feeling is a natural and a proper one, but in consideration of the 
fact that the whole future of the child may depend upon the start it 
makes during the first six or nine months of life, a sensible mother will 
sacrifice her own inclinations, and consent to what she is assured is for 
the benefit of her child. 

[A mother who is nervous, harassed, fretful, grieved, or worried 
is likely to produce a poor quality of milk ; even a poisonous one may 
be ; and she may wisely stand aside and let her babe be nourished from 
some placid, even-tempered wet-nurse. The more a mother can imitate 
the quiet, contented, and mild mannered mental status of the cow, the 
better fitted is she for nursing her infant. If "mental science" or any 
similar forces or influences can be made available for encouraging 
serenity of mothers, it may be very safely so employed.] 

Additions to Milk Diet. — TVhen babies fed by any of the artificial 
means just described have attained the age of six months, it will probably 
be desirable to add some farinaceous food [oat jelly] to their diet, 
being made with the particular preparation of milk upon which the 
infant has been so far reared. When peptonized milk has been used, 
it is desirable now to try to reduce somewhat the amount of peptoniza- 
tion. The peptonizing is intended to assist, not to supplant, the digest- 
ive powers of the infant ; and when it is six months old, and in good 
health, it ought not to require so much assistance as when an infant of 



SPOON-FEEDING. 



*5* 



a few days old. The diminution of the peptonization is best effected 
by allowing the peptonizing agent to act for a shorter time, the process 
being arrested by boiling the milk for a few minutes, five or ten 
minutes after the powder has been added, instead of being continued 
for fifteen or twenty minutes. When it has been customary to give 
the peptonized milk immediately after the peptonizing, without any 
means having been used to arrest the further peptonization, the re- 
duction is best made by diminishing the quantity of the agent employed. 

Spoon=Feeding. — After the age of six months it is usually found 
desirable to give some farinaceous food to babies, even when their 
mothers have been able to nurse them so far without any assistance. 
Foods of either of the three classes mentioned may be used for this 
purpose, being made with cow's milk. It is always best, when pos- 
sible, to dispense with the predigested foods ; and generally at this period 
of life babies will take arrowroot, corn-flour, hominy [or any thorough- 
ly cooked preparations of the cereals], with pleasure, and without any 
subsequent discomfort or difficulty of digestion. Food at this age 
should not be given through a bottle ; the baby should be taught to 
feed from a spoon, and if any milk is given independently of the 
mother's milk, the baby should drink it from a cup. There are two 
advantages to the baby in being fed with a spoon in place of sucking 
its food from a bottle. In the first place, the baby takes it more 
slowly, and the food is thus better mixed with the saliva of the mouth, 
which assists in its digestion ; and in the second place, the food can be 
made thicker and more nutritious. The artificial food should be given 
once or twice daily, at an hour most convenient to relieve the mother 
from her duty of suckling the infant. In children who have been 
brought up artificially, some farinaceous food may be given with 
almost every meal, whether ordinary milk or prepared milk has been 
previously employed. If some malted food of the third kind has been 
used hitherto, this should be varied once or twice a day by a food of 
the second class, and gradually the malted food should be given up. 
and replaced by food of either of the two other classes. It is sometimes 
convenient and admissible, up to the age of one year or a little beyond, 
to give milk from a bottle, and predigested food may also be given in 
the same way ; but for other foods it is always best to adopt a spoon as 
early as possible. 

At the age of nine or ten months a little animal food may be com- 
menced, in the form first of a lightly boiled egg every second day, 
given along with a little thin bread and butter ; and if this agrees U 
may be alternated with some animal soup, chicken and veal broth being 
somewhat preferable to mutton or beef tea. These soups may be 
thickened with a little arrowroot or corn-flour, or some other farinaceous 
food, or they may be given without any addition, accompanied with a 



152 



THE NUTRITION OF THE CHILD. 



little bread. "When eggs are found to agree well, they may be cooked 
in puddings with rice, tapioca, or any other of the various forms of 
starchy food. 

-. [Dr. Rotch says: "TVe have in preparations of oats, both for 
purposes of weaning and for establishing a new variety of diet for the 
infant, a food which in combination with cow's milk, satisfies com- 
pletely the demands at this period for a perfect nutriment. It is best 
to increase gradually the variety of articles of diet from the twelfth to 
the twentieth month, always adapting the food to the especial infant. 
Thus, some infants may be able to digest proportionately large quanti- 
ties of starch ; others may need and digest larger proportions of the 
nitrogenous than the infants just spoken of. Between the twelfth and 
the thirteenth month I am in the habit of giving the infant five meals 
during the day. By this time it is well to accustom it to take its food 
from a spoon, and as soon as possible to omit feeding from the bottle. 
The five meals should be arranged as follows : For breakfast, bread 
and cow's milk, slightly warmed. For lunch, equal parts of oat jelly 
and cow's milk, warmed, with a little salt added according to the 
infant's taste. 

"This meal of oat jelly should be repeated in the middle of the 
afternoon. In the middle of the day, broth of some kind, either chicken 
or mutton, carefully prepared so as to be free from fat on its surface, 
can be given with some bread. The fifth meal should be given late in 
the afternoon, and consist of bread and milk. When the infant is 
fifteen months old some thoroughly boiled rice can be added to the 
broth in the middle of the day, and if it digests this well, some bread 
can also be given at this meal. There are not many fruits which should 
be given to the infant in its second year. A baked apple, or apple 
sauce made without much sugar, can be given, and when peaches are 
in season, a ripe peach, especially if the infant is inclined to constipa- 
tion. Other fruits should be avoided." The writer of this interpola- 
tion would beg to except from this broad exclusion of fruits a baked 
banana, which is certainly nutritious, digestible, and palatable, and 
suitable for weak digestions of either young or old. The well ripened 
banana need only be baked in an oven about fifteen minutes, or re- 
moved earlier if it splits with the heat. It stands with a baked apple 
as a fine food, fit for a prince of royal birth and yet cheap and easy 
enough for even poor folks to obtain.] 

At the age of eighteen months a child is able to masticate tender fish. 
fowl, ot even beef or mutton without its being previously minced ; and 
a little vegetable, in the form of mashed potato, cauliflower, spinach, 
or cabbage may be carefully added to the diet. "When two years of 
life are completed, the teeth are fully developed, and the range of diet 
may be still further widened. [The above advice is permitted to stand 



ERRORS IN DIET OF INFANTS. 



*53 



"as it was written," because it probably fairly represents the average 
professional opinion, but many physicians who think more freely for 
themselves are teaching that most children may be wisely and well 
brought up without any fowl, fish, or meat ; that they are decidedly 
better without it, and if so guided as to diet, will be less liable to chil- 
dren's diseases, better behaved, and more easily trained and kept in the 
tvay they should go. Meats are in fact stimulating foods, and children 
are as a rule better without stimulants of any kind.] 

Nerve Stimulants, such as tea, coffee, and alcoholic fluids, should 
aave no place in the diet of children. They exercise a distinctly in- 
jurious immediate effect upon the digestion, and upon the exceedingly 
sensitive nervous system ; and their habitual use lays the foundation of 
nany nervous disorders in future life. The administration of such 
stimulants is followed by excitement, irritability, and restlessness at 
night, and distaste for more nourishing but less stimulating foods not 
nnfrequently results. No alcoholic preparations of any kind should be 
aver given to children except under medical advice. 

Common Errors in the Diet of Infants. — There are three different 
directions in which the diet of children are apt to be found to err : — 

(1) In the first place, many children suffer from a want of suffi- 
cient fatty food in their diet. The constitutional wants of children 
demand a considerable amount of fat in the food, and this is supplied 
in early life by the cream contained in the milk. If diluted cow's 
milk is employed as a substitute for mother's milk, the proportion of 
cream in it is considerably less, and unless the deficit is made up in 
some way, the child is apt to suffer in health. While taking apparent- 
ly a sufficient quantity of food, it will appear thin, and the limbs, 
instead of being rounded and chubby, will be flaccid and soft. When 
this is observed in a child otherwise apparently healthy, the question 
should always present itself as to whether anything is wanting in the 
diet. If the want is not supplied, the child will continue in depressed 
health, be very easily affected by cold, take bronchitis on slight ex- 
posure, and perhaps when a year or two old develop rickets. There is 
not much difficulty, as a rule, in adequately supplying the deficit. In 
very young life cream may be added to the milk, or a very little cod- 
liver oil may be given once or twice daily. When the child has passed 
the age of six months, a fair quantity of butter may be given with 
bread, or some bread soaked in fat gravy of beef. 

(2) The second error in the diet of children, and perhaps the most 
frequent of the three, is the administration of farinaceous food in 
excess. Under no circumstances can farinaceous food take the place 
of milk, although it is valuable as an addition to it. The milk contains 
certain chemical constituents called azotes, which are absolutely neces- 
sary for the proper nourishment of the body, and which are found only 



154 



THE NUTRITION OF THE CHILD. 



in very minute quantities in farinaceous food. They exist to a much 
greater extent in animal soups, and these can occasionally be made to 
supply for a little time, in conjunction with farinaceous foods, the place 
of milk ; but even in these soups the quantity of azotes is much below 
the requirements of an infant's frame. When farinaceous food is given 
in excess, the digestion of the child becomes irritable, the bowels tend 
to be lax, and the motions smell unpleasantly ; sickness is apt to occur, 
the night's rest is disturbed, and there is a tendency to eczematous 
affections of the skin. "When the excess of farinaceous food is accom- 
panied by a deficit of the nitrogenous food in the form of milk, the 
infant becomes thin, and the face looks pinched and weary. The 
remedy is simple, consisting in reducing the quantity of farinaceous 
food, increasing the amount of milk so far as the digestive powers of 
the child will permit, and adding other nitrogenous foods, such as 
eggs, when the baby has attained an age at which these can be given 
with advantage. 

(3) The third error is one not met with usually until after the first 
year of life, and consists of giving the child a diet too highly nitro- 
genous. This error is very improbable so long as the only nitrogenous 
food given to the baby is milk ; but when eggs, soups, and minced fish 
and fowl are added to the diet, it is not unfrequent to find the child 
suffering from an excess of azotes. Such children usually tend to 
stoutness, and are apt to become somewhat yellow and slightly jaun- 
diced occasionally ; the whites of the eyes lose their clearness, the 
bowels tend to be confined, and the urine to be high-colored and dis- 
agreeable in smell, with an occasional sediment in it. Disturbed sleep 
is common, and grinding of the teeth at night ; and an eczematous 
eruption may occur, situated most frequently in the folds of the elbows 
and knees. The remedy is obvious ; and it need only be remarked that 
no healthy child under the age of jive years will ever suffer from a restric- 
tion of animal food so long as it obtains a full qaantity of milk and cream, 
and a fair allowance of digestible farinaceous food. 

The striking peculiarity of the digestive organs of children 
as compared with those of adults is the facility with which they be- 
come irritated and inflamed. The ingestion of one meal of an improper 
character is quite sufficient to set up inflammation of the lining mem- 
brane of the stomach and bowels which will continue for days, and 
may enfeeble the digestion for weeks. Fortunately, a safeguard is 
provided in the facility with which vomiting is provoked in children, 
an indigestible article of food being frequently vomited before it has 
had time to create much disturbance. But this will not always occur, 
and such small alterations as the very slightest sourness of milk, such 
as might result from leaving it for a little while in a dirty bottle, slight 
rancidity of butter, or some want of freshness in fish, too minute to 



THE NUTRITION OF THE CHILD. I55 

be detected by the senses of the parent, may be sufficient to set up 
acute irritation of the stomach and bowels of the child. No time is 
better spent by a mother than that which is devoted to seeing that the 
meals of the child are properly prepared and carefully administered. 



CHAPTER XIV. 

Physical and Mental Training of the Child. 

Object aimed at; Necessity of Training Faculties ; JResults of Disuse ; Relation 
between Body and Mind ; Importance of Maintenance of Health and Devel- 
opment of Function; Variations in Different Children due to Want of 
Training; Dread of Undue Strain; Value of Effort alternating with Rest ; 
Necessity of Care against unduly Severe or Prolonged Strain; Spontaneous 
Tendency to Movement; Artificial Means of Exercise; Swinging; Military 
Drill; Musical Calisthenics; Dancing; Importance of Regularity in Exer 
cise; Necessity of Due Rest; Training of Special Senses; Mental Training; 
Risk of Overwork; Relation between Fatigue and Want of Interest; Moral 
Training. 

In the cultivation of the physical and mental powers of a child, it 
is necessary to keep in view the object aimed at, as a guide to the 
means to be adopted. That object ought to be the development to 
the highest possible extent of the various faculties with which the 
child is endowed at birth, and the discovery and cultivation of any 
specially valuable tendency which it may have inherited from past 
generations. Both mental and physical powers require to be exercised 
and trained before they can be utilized in the work of life, and disuse 
of any mental faculty is followed by feebleness and atrophy of the 
particular part of the mind involved, quite as inevitably as want of 
exercise of any particular muscle results in its wasting and loss of 
power. The physical and mental powers also are correlated in such a 
way that it is very seldom that good mental work can be done in the 
absence of a fair degree of physical health ; the converse, that mental 
development is essential for the due performance of physical functions 
is, perhaps, not so universally apparent, although in some sense it is 
also true. 

It follows naturally from this that from early life attention should 
be directed specially to the maintenance of the various organs of the body 
in 'perfect health, and to their due functional development. The muscular 
system has to be exercised, so that the muscles may perform their 
work well and quickly, and with proper balance and accuracy ; and 
the control of the muscles by the nervous system should be cultivated 
by exercises involving due rhythm and harmony between different 
parts of the body. The organs of special sense, more especially those 



ALL FUNCTIONS DEVELOP BY USE. 



157 



of sight and hearing, are capable of great development, and call for 
special attention. Nothing is more striking than the variations in the 
faculty of observation noticeable among children. In looking at a 
flower, for instance, one child will see nothing but a mass of color, 
while another of similar age will note different shades of color, differ- 
ent shapes of leaves, and minute peculiarities of structure. Natural abil- 
ity, or perhaps more properly inherited qualities, may account for a part 
of this difference, but it may generally be assumed that in some way or 
another the power of observation has been more highly educated in the 
one child than in the other. 

Effort and Rest. — There not unfrequently exists a rather ex- 
aggerated dread of putting too much strain upon the faculties of chil- 
dren. But all experience points to the fact that education and develop- 
ment, both of bodily and mental functions, is best promoted by a series 
of efforts alternating with periods of rest. It is not by steady and con- 
tinuous hard work that the muscles of the athlete are trained to their 
extreme power ; it is by occasional severe exercise followed by relaxa- 
tion, by the excitement of contest, alternating with the repose of 
achievement. Nor are the highest mental attainments usually associa- 
ted with continuous plodding work ; the triumphs of oratory of the 
statesman aud barrister are followed by periods of recreation and men- 
tal relaxation ; the strain upon the mind of the successful mathema- 
tician or philosopher must be limited in duration, and replaced by 
some totally different variety of occupation. There is no doubt at the 
base of this feeling a grain of truth in the fact that the strain may be 
too severe, or may be unduly prolonged. It is this matter that the 
propriety of due regulation and progressive advancement of different 
exercises for the body and mind falls to be indicated and insisted upon. 
But the possibility of overdoing anything is no reason for its not being 
done at all. The result would scarcely be satisfactory if every child 
were starved on account of a dread of the results following from over- 
indulgence in food. During the first few years of life the spontane- 
ous tendency to movement of every healthy child is sufficient train- 
ing for the muscular system. Every child in normal health is ambi- 
tious of walking and running, and its efforts in acquiring these powers 
exercise fully not only the muscles of the legs but also those of the 
arms and back ; and in the breathlessness produced by exertion the 
lungs and the heart also receive tone and are strengthened. When a 
child is able to walk well, it usually commences to climb on chairs 
and beds, and in this way develops specially the muscles of its arms. 
At this stage of activity, when all experience is new, all the special 
senses are called into requisition, the eyes and ears being always on 
the alert when the child is awake, and the senses of smell, touch, and 
especially taste, being almost continuously exercised. 



158 PHYSICAL AND MENTAL TRAINING OF CHILD. 

Artificial Means of Exercise. — As the child becomes somewhat 
older, reaching the age of four or five years, artificial means of exercise 
should be used to further develop the muscles and strengthen the 
frame. Where available, swinging on a low swing is a very useful 
exercise, strengthening the arms and developing the chest at the same 
time that training is given to the muscles of the body in maintaining 
the balance. Hanging on a trapeze with the hands for a short time 
morning and evening is very valuable in developing the muscles of the 
chest and back as well as of the arms, and has the advantage over 
swinging of being quite free from risk of accident, flilitary drill is now 
introduced into most children's schools, with marked benefLial effects 
on the development of their chests, giving them by this enlargement 
increased breathing power, and consequent general invigoration of 
health. Somewhat similar to this, but even more beneficial, are the 
calisthenics to the accompaniment of music which have lately become 
popular. Hands and feet, arms and legs and bodies are taught to act 
in harmony, -while at the same time the eye and the ear are trained to 
accuracy of sight and sound. When the music is produced by ..he 
vocal efforts of the children singing rhymed words to simple tunes, no 
better physical training can be imagined, and very few indeed can be 
productive of more pleasure to the children. In the same category ot 
exercises, although not of quite so much value, may be placed dancing. 
It is quite a mistake for parents to consider those exercises as only 
amusements. Amusements, fortunately, they are to the children, 
but they are of inestimable value in maintaining the health of the 
body, and have a distinctly beneficial effect on the mental condition, 
even apart and beyond what is due to the satisfactory physical 
well-being. More especially to girls from the age of five to fifteen, 
who are often deprived by custom of many of the physical recrea- 
tions enjoyed by boys, those various muscular exercises are of prime 
importance. 

Developing as they all do the breathing-powers, and necessitating 
deep respiration, it is scarcely necessary to point out the propriety of 
their being carried out in a pure atmosphere, in order that the great- 
est amount of benefit may be derived from them. Where possible, it 
is best that they should be conducted in the open air. Exercises of 
this kind, to be thoroughly useful, should always be practised regularly 
and at frequent intervals. The devotion of half an hour or an hour 
once or twice weekly to drill or calisthenics is of incomparably less 
value than their practice for a quarter of an hour daily. The rule 
which exists now in most boys' public schools, of insisting on every 
boy taking part daily in the recreations and games of the school, unless 
specially exempted by medical order, is a sound one from a physio- 
logical point of view. 



CAUSES OF SPINAL CURVATURE. 



159 



Other exercises of much value in the development of the muscular 
system are riding and swimming, while, for the utilization of the lungs 
to their full extent, nothing is better than singing, especially in part 
songs. 

Importance of Rest. — While the muscular system is thus exer- 
cised, care must be taken to insure due rest at intervals. Much harm is 
sometimes done by forgetting the fact that sitting upright without any 
support to the back gives no rest whatever to the muscles which sup- 
port the body, and in fact puts additional strain upon them. 

In the case of girls especially, whose frames are not so strong as 
those of boys, curvature of the spine, with projection of shoulder- 
blades and inequality in the height of the shoulders, is frequently the 
result of sitting without support for the back djuring the hours of 
school. The strain upon the muscles of the back in such cases pro- 
duces discomfort, which the girl attempts to relieve by sitting in a 
posture which throws the weight more upon the bones and ligaments 
than upon the muscles ; the spine, losing the proper support of the 
muscles, becomes curved to one side or the other, usually assuming 
more or less the form of the letter S, and in time the small bones form- 
ing the spine alter in shape, and permanent deformity results. Girls 
whose muscles are becoming thus weakened and unable to support the 
body properly, can generally be recognized when standing, by their 
resting the weight of the body more on one leg than on the other, and 
leaning slightly over toward the supported side. A habitual attitude 
of that kind when standing should always excite suspicion of commenc- 
ing muscular weakness, and indicate the propriety of regulated exer- 
cise to strengthen, and regulated rest to restore, the fatigued muscles. 
At the period of life in girls from twelve to fifteen, when an additional 
tax is put upon their strength by alterations already described in 
Chapter XL, it is absolute cruelty to expect them to sit at lessons 
for two or three hours daily, without proper support for their backs. 
And this is not afforded even by chairs with backs, unless the backs 
slope outward at a moderate angle from the chair. An absolutely 
upright back is almost valueless ; the back of the chair should slope 
at such an angle as to afford some support for the spine along its 
whole length. 

Curvature of the spine is not the only penalty which neglect of 
these considerations exacts. The initial curvature of the spine is fre- 
quently followed by contraction of the chest and diminution of the 
breathing space, and in the end permanent deterioration of health may 
ensue. Localized muscular fatigue is also not unfrequently the cause 
of emotional outbursts, and many of the so-called hysterical attacks in 
girls may be traced to some unfair tax which has been imposed on the 
muscular system. 



160 PHYSICAL AND MENTAL TRAINING OF CHILD. 

The Training of the Special Senses.— With regard to this, it is 
impossible here to do more than indicate some useful methods. The 
practice of games in which rapid recognition of colors and pictures is 
required, or where rapid enumeration of marks is called for, is valuable 
in trainiDg the eye to quickness and accuracy. The interest of children 
is easily excited in the recognition of common plants, in the shapes and 
colors of their leaves and flowers ; a taste for natural science may thus 
be aroused, while at the same time the sense of sight is cultivated. 

The sense of hearing can be educated by games in which rapid 
association of sound with action is called for. Children living in the 
country should be induced to differentiate the voices of the singing 
birds, and to distinguish other sounds of rural life. When any musical 
appreciation exists, singing should be taught, and opportunities for 
hearing music afforded. 

The sense of touch and what is known as the muscular sense are 
developed best by training in manual employments, such as carpenter 
work and turning for boys, and sewing, knitting, and fancy work 
for girls. 

Mental Training of Children. — There is no risk in the present 
day of this being neglected. The tendency is distinctly toward over- 
pressure, and what is called for is more warning of the evil effects of 
over-taxing the brain than admonitions with regard to its due culture. 
Although the results of over-fatigue of the brain are not so immediately 
obvious as those of over-strain of the muscular system, they are proba- 
bly equally injurious, and of quite as permanent a character. The 
practice which exists in many schools of giving out home lessons to be 
finished when the school hours are over, is responsible for much injury 
to the health both of boys and girls. The brain, like the rest of the 
body, becomes somewhat fatigued toward night, and resents being 
called upon to make exertion at a time when it should be preparing for 
rest. The result is often restless sleep followed by fatigue and irrita- 
bility on waking ; and the natural sequence, impairment of digestion, 
and general deterioration of health. In brain work, more conspicuously 
even than in muscular work, the principle laid down early in this 
chapter, of effort succeeded by rest, calls for full recognition. Close 
attention and real work are possible for two or three hours daily if this 
period is succeeded by mental rest and recreation ; but if the time 
which should be given to those is occupied by home lessons, the in- 
evitable result is carelessness and want of attention during school hours, 
"and mental progress, so far from being expedited, is retarded. 

A Rule of Universal Application is that fatigue is not nearly so 
easily induced when the exercise, be it physical or mental, is pleasur- 
able and suited to the taste, as when it is disagreeable and distasteful. 
An illustration on the physical side is afforded by the distance which 



MAKE EXERCISES AND STUDY INVITING. 161 

can be covered without fatigue in walking with a pleasant companion, 
or through a picturesque country, as compared with that by which 
fatigue is induced if one is solitary, or if the walk be uninteresting. 
It should therefore, as education progresses, be made an object to dis 
cover the particular tastes and tendencies of boys and girls, and to cul- 
tivate those, in preference to following studies which are disliked ; as 
in this way the greater strain can be put on the mental faculties with- 
out fatigue, and the better results accordingly secured. Most boys and 
girls have some favorite study. When this is discovered, opportunity 
for following it should always if possible be afforded, even although 
the study may not commend itself to the parent or guardian as the 
most useful, or the one most calculated to insure success in after life. 
Any study which is followed out with thoroughness and enthusiasm is 
of immense value in training the mind, even when it cannot always be 
considered as advantageous from a ' ' paying " point of view. 

Formation of Moral Character.— It would be out of place to say 
much here about the moral training of children. This must depeud 
upon their parents, their teachers, their companions, and, to some 
extent, their books. Judicious parents will always exercise due su- 
pervision over the companions with whom their children associate, and 
the books which occupy part of their leisure hours. It is in early life 
that the foundation of future character is laid ; and it should always 
be borne in mind that the force of example is infinitely stronger than 
the influence of precept or doctrine. Parents and teachers can scarcely 
expect to find in their children and pupils virtues of the possession of 
which they themselves afford no evidence. 



^J$> 



CHAPTER XV. 

Some Congenital Defects in Children. 

"Mothers' Marks"; Cause; Treatment; Club-Foot; Hair-Lip; Supernumer- 
ary Fingers and Toes; Hernia: Umbilical, Inguinal; Hernia in Middle Line 
of Abdomen; Imperforate Lachrymal Ducts; Liability to be Mistaken for 
Inflammation; Imperfections of Sight; Short-sight; Long-sight; Astigma- 
tism; Squinting, Curability; Detection of Short-sight; Of Astigmatism. 

"While the vast majority of children are born with bodies practically 
perfect in structure, a small proportion are found to exhibit imperfec- 
tions of different kinds, some of which are remediable by surgical or 
other means. Attention will be called in this chapter to some of those 
defects capable of remedy, their appearance will be described, and the 
propriety of steps being adopted for their relief will be indicated. 

Naevi. — Among the most common imperfections of young infants 
is the presence on the skin of what are known popularly as mothers' 
marks, and scientifically as ncevi. A mother's mark or naevus appears 
as a red or purplish patch upon the skin, sometimes elevated, some- 
times on the same level as the healthy skin around. Nsevi vary very 
much in size, being seen as small as a split pea, while they occa- 
sionally extend over a considerable part of the body. Most com- 
monly they are about the size of a sixpenny bit or a shilling 
[a dime or a quarter dollar]. Sometimes their edge is sharply 
defined ; at other times the edges are indented, and little processes 
are thrown out like the straggling legs of a spider. They result 
from an abnormal enlargement of the superficial blood-vessels, and can 
often be made partially to disappear by pressure being applied to them, 
returning when the pressure is removed. There is a popular belief 
that they are frequently caused by some vivid impression which has 
been made on the mother before the birth of the child ; and they are 
sometimes supposed to represent the outline of some animal or other 
object which may have caused alarm to the mother. It is this supposi- 
tion which has gained for them the name of mothers' marks, but it is 
exceedingly doubtful if there is any real foundation for this hypothesis. 
The smaller nsevi are usually cured without much difficulty, and it is 
desirable that they should be dealt with in the first few months of life, 
especially if they are seen to be increasing la size, as they are somewhat 

162 



DEFORMITY OF THE FEET. 



163 



prone to do. Frequently they are destroyed satisfactorily by perform- 
ing vaccination upon them ; if this is not convenient, they can be re- 
moved by burning with strong nitric acid, the pain of the application 
of which only lasts for one or two minutes. The larger ones require 
rather more elaborate surgical treatment, but can generally be removed 
without, any very unsightly cicatrix being left behind. It is always 
well to have them removed when possible, as in the first place they 
generally tend to grow, and may become dangerously large, and in the 
second place, when on any part of the body exposed to view they are 
very unsightly. It is only the very small ones which ever disappear 
spontaneously, and even with these disappearance without treatment 
is rare. 

Fig. 23. 





TWO FOKMS OF CLUB-FEET. 



[ The use of strong acids, such as nitric, named above, had better 
be left to surgeons. For "home use" it is too sharp and strong, but the 
Sanitary Caustic can be safely applied in such cases by any reasonably 
careful person, and has been found effective in removing naevi of con- 
siderable size. See page 1230.] 

Clubfoot. — A deformity which is not very rare, and which is 
usually very amenable to early treatment, is "club-foot." This consists 
of a malformation, in which the foot is twisted in some peculiar direc- 
tion, so that the sole cannot be placed properly on the ground when 
the child is held erect. The foot may be twisted upward or down- 
ward, inward or outward, and there may be a combination of these 
directions ; the more common instances of club-foot being those in 
which the foot is twisted downward and inward, and in which it is 
displaced upward and outward. Club-foot may affect only one foot, 
or it may occur in both feet. It is caused by some want of balance 
between the muscles acting on the different parts of the foot ; and it is 




1 64 SOME CONGENITAL DEFECTS IN CHILDREN 

usually rectified by restoring the balance by means of small operations 
intended to lengthen the tendons of particular muscles, and by altering 
the position of the feet with the aid of splints or bandages of plaster of 
Paris. It is of much importance that the cure should be carried out 
early in life, as, if operation is postponed too long, the bones of the 
foot become altered in shape by the pressure resulting from the mis- 
placement, and the result of operation is not so completely satisfactory. 
Hare=lip.— The presence of hare-lip in babies calls also for very 
early operation, if the result is to be thoroughly satisfactory. Hare-lip 
is the name given to a form of imperfect development affecting the 
upper lip, which is completely divided near the centre by a deep fur- 
row, reaching from the pillar of the nose to the mouth. Sometimes the 
Fig. 24. division affects also the upper gum and the roof of 

the mouth, extending back to the uvula ; occasion- 
ally there is a double division of the lip, with a 
projection of skin between them, attached at its 
base to the nose. Unpromising as such cases may 
at first sight appear, they are perfectly amenable 
to treatment by surgical operation ; and a success- 
""^ ful operation in early life usually results in the 

single hake-lip. restoration of the proper outline of the lip, leaving 
behind, as the only trace of the deformity, a comparatively inconspic- 
uous cicatrix, with perhaps a very slight groove in the edge of the lip 
where the fissure originally commenced. Where the hare-lip has been 
double there may remain two parallel cicatrices in place of one, but 
this does not add to the conspicuousness of the scar, and even some- 
times diminishes it. 

Supernumerary Fingers and Toes. — Babies are occasionally 
born with supernumerary fingers and toes ; and when these are in such 
a position as to be inconvenient when the child grows older, or to look 
unsightly, they ought to be removed as soon after birth as possible. 
Very young babies bear exceedingly w T ell small operations in which no 
loss of blood is involved, and although they experience pain at the 
time of the operation, certainly are not so sensible of any subsequent 
discomfort as children of an older growth. 

Hernia, or rupture of a part of the bowel through some weak 
point in the abdominal walls, is a common defect in young infants. 
There are three specially weak points in the walls of the abdomen 
where ruptures are prone to occur. 

1. The situation at which ruptures most frequently are observed 
in infants is at the navel, where at birth the umbilical cord is attached. 
The wall of the abdomen at this point is naturally somewhat weak in 
infants, and any exceptional strain upon it, such as may result from its 
being dragged upon by the cord at birth, or being pressed outward by 



INFANTILE HERNIA OR RUPTURE. 165 

frequent and violent crying, is apt to cause a small piece of bowel to 
project in such a way as to form a small tumor under the skin. That 
such a tumor is a rupture or hernia can usually be demonstrated by 
the possibility of gently pressing it backward into the abdomen so as 
to make it disappear, and by its return when the pressure is removed, 
and the infant begins to cry. 

Such umbilical hernia;, as they are called, are generally of small 
size, rarely exceeding the dimensions of a plum, and usually only at- 
taining the size of a large thimble. With reasonable care and treat- 
ment, they are invariably cured. All that is required for the cure is 
that an elastic belt with a small flat pad over the navel should be ad- 
justed to the infant, and maintained in its position for six months or a 
year, only being removed for the purpose of washing. The belt should 
be three or four inches in breadth, and is best made with silk elastic 
attached to linen, so as to allow of adjusting the pressure by lacing at 
the back ; but if care is taken to prevent any irritation of the skin, a 
plain india-rubber band may be used. The pressure of the belt should 
be just sufficient to keep the hernia from projecting outward. 

2. The second site at which hernias are commonly seen is just 
above the groin on either side of the body. Herniae occurring at this 
situation are called inguinal hernia?, and are met with almost exclu- 
sively in male infants only. They vary in size more than umbilical 
hernia?, but do not project so much even when large, taking a course 
downward under the skin into the scrotum, instead of pushing their 
way straight outward. They are recognized by the same characters 
as the umbilical herniae, being returnable into the abdomen by gentle 
pressure, and being forced out again by crying or other exertion on the 
part of the infant. 

Considerable care and attention must be directed to their cure. It 
is necessary to have a proper truss adjusted, and to have it altered from 
time to time to keep pace with the growth of the child. In the first 
six months of the infant's life much difficulty is usually experienced in 
preventing the truss from irritating the skin upon which it presses. 
Trusses covered entirely with india-rubber are usually employed, as 
they do not suffer injury from being wetted with urine. The truss 
must always be kept as clean and as dry as possible, and the skin under- 
neath where the truss presses must be washed, dried carefully, and 
powdered each time that the diapers are changed. It is very seldom 
that an inguinal hernia is cured in less than a year, and not unfre- 
quently two or three years must be allowed to elapse before the truss 
can be safely dispensed with. 

3. The third situation where herniae are occasionally met with in 
infants is in the middle line of the abdomen, at any point between 
the end of the breastbone and the navel. Hernia? occurring here are 



!66 SOME CONGENITAL DEFECTS IN CHILDREN. 

almost invariably very small, often not exceeding the size of a pea. 
They are, however, not unfrequently the source of pain, and their dim- 
inutive size occasionally leads to their being overlooked, more especially 
as in well-nourished children they can sometimes only be felt and not 
seen. Their character is demonstrated by their disappearance under 
pressure, and their reappearance afterward. For their cure a belt 
similar to that recommended for umbilical hernia must be employed, 
the pad being placed so as to press upon the site of the rupture. 

Defects of the Eye. — Children are occasionally born with an im- 
perforate condition of the small canals which carry off the secretion 
of the eyes to the interior of the nose. Normally, from the inner cor- 
ners of the lower and upper eyelids two small tubes arise, and run in- 
ward to a small bag which lies between the inner corner of the eye and 
the nose, from which a somewhat larger tube or canal leads into the 
back of the nose. The commencement of the small tubes can be seen 
distinctly if the eyelids are slightly everted. The secretion from the 
eye, including the tears, after passing over the eye, flows down these 
small tubes, and is carried through the bag or sac, as it is termed, into 
the nose. If these tubes are imperforate, the secretion escapes at the 
inner corner of the eye, and flows down the cheek, producing in time 
considerable irritation. When this first occurs, it is apt to be mistaken 
for slight inflammation of the eye, and the mistake is a natural one, as 
the secretion, if it does not find its proper exit through the tubes, is 
apt to set up a little inflammation. "When, however, the condition 
recurs again and again, suspicion should always arise as to the possi- 
bility of want of patency of the tubes, and the attention of the medical 
attendant should be called to the matter. In most cases only a very 
slight operation is required to open up the tubes ; but. as a rule, it will 
have to be done under an anaesthetic on account of the delicacy of 
manipulation required, and the risk of damage from sudden movement 
of the child. 

The most frequent and the most important of all congenital defects 
are imperfections of Vision. As an optical instrument, the eye is 
not always by any means all that one could desire, although its defici- 
encies do not usually become apparent until a few years have elapsed 
from birth. Most people are aware that, on looking through a tele- 
scope or field-glass, some adjustment has usually to be made to bring 
objects into focus before they can be seen clearly. Now the most fre- 
quent congenital defect in eyes is that they are not focussed properly 
for the external objects at which they are intended to gaze. A certain 
power of altering the focus is possessed by all eyes, but it is limited, 
while the divergences in structure much exceed the bounds of these 
limits. It results that some eyes can only see clearly objects very near 
to them, when they are called short-sighted, or myopic ; or can only see. 



CONGENITAL FAULTS OF VISION. 167 

distinctly objects at a distance, when they are named long-sighted or 
hypermetropic. Some eyes are so very inconveniently formed that 
they are long-sighted for perpendicular objects, and short-sighted for 
horizontal objects, or the reverse, so that a person with such eyes 
might read distinctly a clock face at a distance when the hour was 
half-past twelve, but could not see the hands at all when they were 
placed at fifteen minutes to three. Such eyes are called astigmatic. 

Of the three forms of abnormality of sight, the one usually dis- 
covered earliest is long-sight or hypermetropia, and for the reason 
that it very frequently gives rise to the unsightly affection known a? 
" squint." 

Squinting in children is almost invariably the result of some im- 
perfection of sight, and in the great majority of cases the imperfection 
is hypermetropia. The reason of this cannot be fully explained here, 
but it may be said in general terms that it results from the effort made 
by a long-sighted child to get clear vision of objects in close proximity 
to him. The squint is thus most likely to occur at an age when the 
child begins to make use of playthings requiring accurate vision, such 
as puzzles, pictures, etc. When any abnormal position of one eye with 
relation to the other is noticed on a child concentrating its attention 
upon any object, it is time to take medical advice respecting the con- 
dition of the accommodation of the eyes. If neglected, the squint may 
in time become permanent, and not only is the result unsightly, but 
often the sight is still further impaired. At the. same time, it is never 
too late to take advice regarding the visual powers ; and squints of 
considerable duration can frequently be cured by the employment of 
properly selected spectacles. As a rule, children do not at all dislike 
wearing glasses, and even when only three or four years old will take 
good care of them and keep them from injury. 

Short-sight or myopia does not usually make itself apparent so 
early as hypermetropia, as it is much less frequently the cause of squint. 
It is most commonly first detected when the child goes to school, it 
being remarked that it cannot see clearly figures drawn on a black 
board, or letters of large type at a distance. Children suffering from 
short-sightedness are not unfrequently punished for errors which seem 
faults due to inattention and stupidity, but which are really attribu- 
table to the imperfection of their sight. When a child complains that 
it cannot read or see distinctly what is quite apparent to other children 
at the same distance, the possibility of the existence of short sighted- 
ness should always present itself to the teacher or mother. The exist- 
ence of astigmatism is usually discovered in the examination of the 
eyes when short-sightedness or long-sightedness has been suspected, 
one or other of these usually predominating in an astigmatic eye, and 
calling for correction before the astigmatism is dealt with. 



CHAPTER XVI. 

Hints on Nursing Children during Illness. 

Duties of a Nurse ; Observation of the Patient ; Respiration ; Pulse ; Tempera- 
ture; The Clinical Thermometer; Hygiene of Sick-room; Cleanliness; Ven- 
tilation, Temperature; Light and Sunshine ; Hygiene of Invalid: Cleanli- 
ness; Clothing; Food; Administration and Application of Remedial 
Agents; Mixtures; Powders; External Applications; Warm Fomentations ; 
Spongio-piline; Poultices: Linseed Poultice, Bread Poultice, Starch Poul- 
tice ; Application of Dry Heat, of Cold; Compresses; Counter-irritation; 
Stimulating Liniments ; Mustard Plasters ; Poultices; Turpentine Stoups; 
Medicated Applications; Sedative Liniments; Ointments; Lotions; Syring- 
ing of Ears; Applications to Throat; Leeches ; Management of Infectious 
Diseases; Disinfectants, Their Abuse. 

Duties of a Nurse during Illness.— The duties which a nurse 
may be called upon to perform during illness may be most conveniently 
described under three heads : the observation of the patient, the main- 
tenance of the patient and the sick-room in thorough sanitary order, 
and the administration and application of remedial agents. 

I. Observation of the Patient. — This duty, one of the most 
interesting to a careful and enthusiastic nurse, is also, in the case of 
illness in children so young as to be unable to describe their sensations 
and to indicate sources of discomfort and pain, one of great importance. 
The medical attendant only sees his patient for a short time daily, and 
must depend upon the intelligence and watchfulness of the nurse for an 
accurate account of any symptoms which may have presented them- 
selves in the intervals between his visits. Nurses desirous of satisfac • 
torily fulfilling their duties should train themselves to note carefully, 
and to report conscientiously, anything with reference to the patient 
which may throw light on the character or progress of the illness. It 
is not for the nurse to judge of the value of any symptom which may 
present itself ; its existence should merely be remarked, and related to 
the medical attendant on the first opportunity. 

An enumeration of the principal facts upon which the nurse is ex- 
pected to afford information to the doctor in attendance will include, 
in the first place, an intelligent description of the general demeanor 
of the patient, whether restless, irritable, quiet, somnolent, or cheer- 
ful. It will also include an account of the appetite of the invalid, 

168 



THE STUDY OF SYMPTOMS. 169 

of the quantity of food taken, and of the amount of sleep obtained 
during the night. The nurse will also be relied upon to mention 
any alterations which may have occurred in the appearance of the 
invalid, the presence of any pallor or flushing of the face, of any sick- 
ness ; of delirium, of twitching of the muscles, or generally of any 
phenomena indicative of a departure from health. When cough is 
present, she should be able to describe in general terms its frequenc} r 
and character ; and if expectoration exists, to indicate its appearance 
and amount. She should also be in a position to state the frequency 
with which the bowels and kidneys have acted, and to give a descrip- 
tion of the character of their excretions. In her daily ablution of the 
invalid she is afforded an opportunity of observing any unusual appear- 
ance of the skin ; and the existence of any eruption or rash, however 
slight, should always be remarked, as its presence may be of much 
significance. There are three special symptoms which nurses are ex- 
pected to observe and report upon, and about which it is desirable they 
should possess some information. 

1. The first of these is the frequency of respiration or breath = 
ing. In many diseases of the heart and lungs the frequency of breath- 
ing throws much light on the severity and progress of the illness, and 
an exact record taken at different periods of the day is of much value 
to the medical attendant. It is customary to describe the frequency by 
counting the number of respirations or acts of breathing occurring in 
one minute, the enumeration being effected with the aid of a watch 
provided with a seconds' hand. In general, there is no difficulty in 
distinguishing each act of respiration by watching the movement of the 
chest, which rises and expands during inspiration, and falls and con- 
tracts during expiration. When the breathing is so shallow as to render 
the movement inconspicuous, it may be felt by placing the hand gently 
on the front of the chest. Not unfrequently the successive acts of in- 
spiration are quite audible, and can be counted by attentive listening. 
Sometimes, more especially when breathing is difficult, each inspiratory 
act is accompanied by dilatation of the nostrils, by watching which the 
rapidity of breathing can be estimated. 

The normal frequency of respiration in a healthy child varies 
from twenty to twenty-five breaths per minute ; in disease it may 
increase beyond eighty per minute, or fall below fifteen. When the 
nurse has enumerated the acts of breathing in one minute, she should 
make a written note of the number, and the hour at which the observa- 
tion was made, and should at the same time remark any peculiarity 
connected with the respiration, such as irregularity in rhythm, or the 
presence of wheezing, snoring, or hissing sounds. 

2. The second special symptom which the nurse is expected to 

record is the frequency of the pulse. 

6a 



l 7 o HINTS ON NURSING CHILDREN DURING ILLNESS. 

The pulse, which beats synchronously with the heart, and indicates 
the frequency and to some extent the strength of its action, is usually 
felt about an inch above the base of the thumb, on the outer side of 
the wrist, where an artery of medium size passes over one of the bones 
of the fore-arm. This artery is selected chiefly on account of its super- 
ficial position and its relation to the bone behind it, which forms a 
resisting surface against which the artery can be pressed by the fingers. 
Every artery in the body pulsates in a similar manner, and when from 
some abnormality of position of the radial artery, as it is named, the 
pulse cannot be felt in the usual position, an artery on the inner side of 
the wrist may be utilized, or the pulsations of the heart itself against the 
wall of the chest may be counted. In counting the pulse in the usual 
position, one or two fingers are laid upon the artery, which they press 
gently against the bone behind. The pulsations are usually easily 
recognized as successive gentle beats against the fingers, and are count- 
ed with the aid of the seconds' hand of a watch. A convenient method 
is to count the number of beats in four successive quarters of a minute, 
and to add the four numbers together to arrive at the number of beats 
per minute, which is recorded as the pulse-rate. By taking the pulse in 
this way, its regularity or irregularity is ascertained, as well as its 
frequency. 

The Normal Pulse in Children varies from about 120 beats per 
minute in infancy to about 90 after the age of two years. Very slight 
disturbances are apt to increase the frequency considerably, and with 
only moderate fever a rapidity of 150 or 160 beats per minute may be 
attained. On account of the extreme susceptibility of the action of the 
heart to comparatively small influences, the information given by in- 
creased rapidity of the pulse in disease in children is not by any means 
so valuable as that afforded in the case of adults ; its importance, how- 
ever, increases with the age of the child, while abnormal slowness is 
always a symptom of much value, and generally one of serious import. 

3. The third special symptom to be recorded by the nurse is the 
temperature of the patient, a symptom of much significance and 
value to the medical attendant. To ascertain the temperature of an 
invalid, the nurse makes use of a thermometer of peculiar construction, 
called a clinical thermometer. This instrument differs from an ordinary 
thermometer chiefly in the fact that the thin column of mercury con- 
tained in it does not fall when exposed to cold, although it rises when 
exposed to heat, the height of the column of mercury at any time thus 
indicating the highest degree of heat to which the thermometer has 
been exposed. Another point of difference is that although the mer- 
cury does not fall when exposed to cold, it can be shaken or knocked 
gently downward until the column recedes almost entirely into the 
bulb of the thermometer. A third distinctive point is that the range 



NORMAL HUMAN TEMPERATURE. t y t 

of the scale is much more limited than in an ordinary thermometer, 
generally extending from about 95° F. at the lower end to 110° F. or 
112° F. at the higher end. The reason for this limitation is that this 
range represents practically the extreme variations of the temperature 
of the human body in disease. 

The Normal Temperature of the Human Body in Health is 
remarkably constant at all ages and under all circumstances, seldom 
varying more than three or four tenths of a degree above or below 
98.4° F., which is generally marked on clinical thermometers as the 
normal point. Some slight difference is noticed according to the posi- 
tion in which the thermometer is placed when the temperature is taken. 
Most commonly the bulb of the thermometer is placed within the arm- 
pit, while the arm is pressed closely against the side ; but in certain 
circumstances a more accurate record is obtained by placing the bulb 
of the instrument under the tongue, while the stem is held between the 
lips. In the latter position the thermometer usually registers a tempera- 
ture one or two tenths of a degree higher than when placed in the arm- 
pit. In the scale of a clinical thermometer each degree is usually 

Fig. 25. 



Bgjjj^ Si B ten^^ 



r 7rn-m^njTTlfTwnTfr_33 , fra^ 



CLINICAL THERMOMETER. 

divided by four small lines, the space between each of which represents 
one fifth of a degree ; the half of such space thus represents one tenth 
of a degree, which is represented in writing by a decimal figure. 
Before taking the temperature of a patient, the nurse must "set" the 
thermometer by shaking down the column of mercury until it falls one 
or two degrees below the normal point of 98.4° F. This is most easily 
managed by giving the instrument a few sharp jerks, or by holding it 
in one hand, with the bulb downward, and striking that hand gently 
against the other, taking care to avoid injury to the thermometer. 
When properly set, it is placed either in the armpit or under the tongue 
of the patient, and left there for four or five minutes, the time re- 
quired varying with the sensitiveness of the thermometer. It is then 
removed, and the height to which the column of mercury has risen is 
read off in degrees and tenths of degrees, and noted in decimal notation. 
For example, if the mercury has risen to exactly the middle point be- 
tween 100° F. and 101° F., its height is recorded in 100.5° F.; if it has 
risen to four-fifths of a degree above 100° F., it is registered in 100.8° 
F. It is desirable to note in writing at once both the height of the 
temperature, and the hour at which it has been taken. 

When any variation from the normal heat of the body occurs dur- 
ing illness, it is almost invariably an increase of temperature which is 



172 



HINTS ON NURSING CHILDREN DURING ILLNESS. 



observed. Feverishness, which is a very common characteristic of 
many disorders, involves increase of temperature, varying in different 
cases from one or two, to seven or eight degrees. Under ordinary cir- 
cumstances of illness accompanied by fever, it is seldom that a tem- 
perature higher than 104° F., or 105° F. is observed ; but in severe 
cases the temperature of the invalid may rise to 107° F. or 108° F., or 
even further. Any temperature exceeding 105° F. is generally indica- 
tive of considerable severity of disease. Reduction of temperature 
below the normal point occurs sometimes to a slight extent in illnesses 
where much weakness exists, and in convalescence from acute diseases ; 
the reduction seldom exceeds one or two degrees, and does not as a 
rule give rise to anxiety. 

II. Hygiene of the Sick=room and Patient.— The second de- 
partment of the duties of a nurse is the maintenance of the sick-room 
and patient in perfect sanitary order. The sanitary requirements of a 
sick-room are cleanliness, pure air, regulated temperature, and light, 
including as much sunlight as possible ; of an invalid, cleanliness, 
suitable clothing, and appropriate food. Some suggestions remain to 
be made under each of these heads. 

Cleanliness of the Sick=room.— The maintenance of cleanliness 
is one of the most important duties of a nurse ; it has been said, indeed, 
by Florence Nightingale, the originator of scientific nursing, that "the 
fear of dirt is the beginning of good nursing." Not only must the bed 
and bedding upon which the child lies be kept scrupulously clean, but 
every part of the room and its contents should be carefully supervised, 
and all dust and dirt removed. When possible, carpets and stuff cur- 
tains should be taken out of the room in which an invalid is residing ; 
if desired for the sake of appearance, one or two rugs, which can be re- 
moved from the room and shaken well every day, may be substituted 
for the carpets, while light washing curtains may replace the stuff 
ones. All unnecessary furniture should be dispensed with, not only 
because it affords a refuge for dirt, but also because it occupies space 
which may be more satisfactorily filled with fresh air. The floor of 
a sick-room should not be swept, but should be rubbed over carefully 
with a wel; c!oth ; and furniture should be kept clean in the same way. 
The ordinary process of what is called "dusting" generally consists of 
removing dust from a conspicuous place where it can be seen, to an 
inconspicuous place where it is out of sight, but equally capable of 
doing harm, and is quite inappropriate to the sanitary wants of a sick- 
chamber. No dishes with foods or drinks should be allowed to remain 
in the room longer than they are required for use : they should always 
be removed and cleaned immediately. This remark applies even more 
strongly to sanitary utensils, such as bed-pans, and urinary recepta- 
cles ; these should always be removed from the room, with a cover 



VENTILATION OF THE SICK ROOM. 



173 



over them, immediately after they are used, and not brought back until 
again wanted. 

It is most important in the interests of the invalid that the bed and 
bedding should be maintained in as clean and well-aired condition 
as possible. From the human skin, both in health and in illness, 
vapor is constantly excreted, containing impure emanations, which are 
absorbed by the clothing and by the coverings of the bed. It is neces 
sary that these should be removed from the bedding by frequent airing, 
otherwise they accumulate to such an extent as to be positively injuri- 
ous to the invalid. In severe illnesses of some duration the most con- 
venient method of maintaining purity of the bedding is to have two 
separate beds — one for day use and the other for night use ; and to air 
the bed-clothes thoroughly every day, by exposing them for some hours 
either to the rays of the sun in a thoroughly ventilated room, or before 
the flame of an open fire. When this arrangement is impracticable, a 
double set of sheets should be used, and changed morning and evening, 
being thoroughly aired before being replaced on the bed. 

Ventilation of the Sick=room. — The air in every inhabited room 
J3 constantly undergoing contamination from the various impurities 
excreted from the lungs and skin of the persons living in it ; and in 
order that the atmosphere of the room may not become injurious to the 
inhabitants, it is necessary that some arrangement should exist for the 
continuous removal of the impure air, and for its replacement by a 
fresh and pure supply. The substitution of the pure for the impure 
air takes place in two different ways. In the first place, air, like other 
gases, possesses the property of "diffusion," by which is meant that 
when two gases of any kind, such for instance as oxygen and nitrogen, 
or pure and impure air, come in contact intimately, they intermingle 
closely with each other, instead of remaining separate as two fluids, oil 
and water for example, would. The interstices of the windows and 
doors of a room, the open chimney, and the door afford facilities for 
this intermingling, and contribute considerably to satisfactory ventila- 
tion. But the more important factor in ventilation is the quality which 
air possesses, in common with other gases and fluids, of becoming 
heavier when its temperature is reduced, and lighter when its tempera- 
ture is raised. The heavier air tends naturally to fall and to displace 
upward the lighter air, which is pushed out at any convenient outlet 
by the cool air entering at any available inlet. Most of the agencies 
which tend to render the atmosphere of a room impure tend also to 
raise its temperature, so that the temperature of a room requiring fresh 
air is usually higher than that of the external fresh air surrounding it. 
The heavier external air is thus constantly attacking and invading the 
lighter internal air, and driving it outward laden with its required im- 
purities, 



I 7 4 HINTS ON NURSING CHILDREN DURING ILLNESS. 

In any room unprovided with special arrangements for ventilation, 
the fresh and pure air enters by the interstices of the window, and 
generally of the door also, while the warm and impure air finds its exit 
usually by the chimney. If no chimney exists, the fresh air entering 
by the interstices of the window will expel the contaminated air through 
those of the door ; but the interchange of air will be much slower than 
when a chimney exists. The importance of the chimney of a room as 
an aid to ventilation is not unfrequently overlooked ; and indeed, from 
ignorance, the chimney is sometimes rendered useless by the closure of 
the flue, when no fire is required. Unless other means of ventilation 
have been specially arranged, chimneys ought always to be left open, 
and to be kept clean. When a fire is burning in the grate, the value of 
the chimney as an exhauster of impure air is much enhanced, the 
greatly increased temperature of the air in the chimney resulting from 
the fire beneath giving rise to a continuous upward current, which aids 
most effectively in ventilating the room. 

The risks to be avoided or overcome in ventilating a room, when 
die external temperature is considerably lower than that of the interior, 
are the undue lowering of the temperature of the room, and the occur- 
rence of "draughts" or currents of cold air. These must be obviated 
by admitting the fresh and colder air in such manner as to intermingle 
thoroughly with the warmer air within, and in such quantity as not to 
unduly depress the temperature. Generally speaking, the opening of 
the upper part of the window to a small extent affords the most con- 
venient ingress for fresh air, as it then comes immediately in contact 
with the warmed air near the ceiling of the room, and is raised in tem- 
perature while falling downward through it. Another convenient 
entrance for pure air can without much difficulty be arranged in the 
middle of the window by raising the lower sash one or two inches, and 
filling up the space left below by a board of wood fitted for the purpose. 
A space is thus formed between the upper and lower sashes communi- 
cating with the external air, which on entering is directed upward to 
the ceiling, and thus becomes warmed. 

When the external temperature is too low to admit of any part of 
the window being continuously open, the atmosphere of the room can 
be sufficiently freshened by opening the window widely for two or 
three minutes occasionally, at the same time covering the child's head 
as well as its body thoroughly with the bed-clothes. This should not 
be done, however, in cases where great uniformity of temperature is 
essential to the treatment. 

In such cases, and in others where ventilation by open windows is 
undesirable, the door of the room may be utilized to admit air which 
has already been partially warmed in its transit through the house. 
When a door is left partially open to admit fresh air, it should always 



TEMPERATURE OF THE SICK-ROOM. l 75 

be fixed in position by a small wedge, or by a weight placed on either 
side, as any noise occasioned by its accidental movement is irritating to 
an invalid. 

When fresh air is introduced by any of the methods mentioned 
into a room of fair size, no "draughts," as a rule, will be perceived. 
If, on account of the shape of the room, or from other causes, cold 
currents of air are found to be present, the bed of the patient must be 
placed in such a position as not to be affected by them ; or their course 
must be diverted by the employment of movable screens. The necessity 
of efficient ventilation should always be kept in view by a nurse ; in 
all cases of illness it is of much value, in many cases it is of abso- 
lutely vital importance to the welfare of the invalid. 

Temperature of the Sick-room. — The maintenance of a fairly 
uniform temperature in the sick-room is called for in most diseases of 
any severity, and in a climate so variable as that of England claims 
considerable attention from the nurse. It is very seldom that the ex- 
ternal temperature, even during the day, remains as constant as is de- 
sirable in many cases of serious illness, while the very great difference 
between the temperature of midday and midnight, at almost all seasons 
of the year, renders it absolutely necessary to resort to means and 
appliances for artificially modifying the degree of warmth of the in- 
valid's chamber. For the purpose of satisfactorily regulating the tem- 
perature, a thermometer should be placed in some part of the room in 
such a position that it is not subjected to the direct rays of the sun or 
of an open fire. 

The temperature at which a sick-room should be maintained will 
vary somewhat with the character of the illness, and with the wishes 
of the medical attendant. Generally speaking, it should not be allowed 
to fall below 60° F. or to rise above 65° F. In some cases of illness, 
more especially when the lungs are affected, a constant temperature of 
70° F. may be demanded ; and even a higher temperature than this 
may be exceptionally useful, in diseases where artificial moisture as 
well as elevated temperature is called for. 

When attainable, the rays of the sun should .always be utilized for 
raising the temperature of an invalid's room, in preference to any arti- 
ficial source of heat. These rays not only warm the atmosphere, but 
also purify the air, while in addition they undoubtedly exercise a bene- 
ficial influence on the progress of many diseases. 

When the rays of the sun are not available, recourse must be had 
to artificial sources of heat, and of these, open coal fires are to be pre- 
ferred to any other methods of raising the temperature of a room. The 
one drawback to their employment is the occasional disturbance to the 
patient involved in the addition of fresh coals, and in the use of the 
poker. The former difficulty is, however, easily overcome by wrapping 



j 7 6 HINTS OX NURSING CHILDREN DURING ILLNESS. 

up previously small quantities of coal in paper parcels, each sufficient 
for one addition to the fire, and placing the parcels quietly, as required, 
on the top of the burning coals. If this is done judiciously, and a good 
burning coal be selected, the use of the poker may generally be dis- 
pensed -with altogether. 

When gas fires are employed in a bedroom, great care must be 
taken that the ventilation is satisfactory, and that theup-draught of the 
chimney is sufficient to carry away all the noxious fumes resulting from 
the combustion of gas. Unlike the smoke of coal, the products of 
combustion of gas are invisible, but are none the less injurious. Fortu- 
nately, however, their presence in the atmosphere in any appreciable 
quantity can usually be detected by the sense of smell. Gas fires dry 
the atmosphere much more than coal fires, and for this reason are 
ineligible in cases of disease of the throat and lungs, in which generally 
a very moist atmosphere is desirable. To some extent this defect may 
be remedied by the use of water-evaporating dishes in the proximity of 
the gas fire, but it is seldom that even by their aid a perfectly satisfac- 
tory condition of the atmosphere is attained. 

It is seldom that any measures have to be taken in England to re- 
duce the temperature of an invalid's room, there being usually no risk 
or discomfort involved to the invalid in a rise of temperature of several 
degrees beyond what is considered desirable for the particular disease, 
such as would result from a fall to the same extent, When it is con- 
sidered necessary to cool the atmosphere of the room, the exclusion ol 
the rays of the sun by dark blinds, and the free opening of windows 
and doors, will generally effect the end in view. 

Light and Sunshine in the 5ick=room. — The value of light and 
sunshine in the treatment of disease has been much insisted on of late 
years. Irrespective of the close relationship between light and cleanli- 
ness, evidence has shown conclusively the near connection between 
light and vitality ; the processes of nutrition and assimilation are found 
to progress more satisfactorily, and the power of resistance to noxious 
influences to increase, in proportion to the abundance of light. In 
cases of illness where there exists Intolerance of light, a screen should 
be arranged if possible to protect the eyes of the invalid while the light 
is admitted to the rest of the room, or curtains may be hung tempora- 
rily on one side of the bed ; but the whole room should not be dark- 
ened unless by the doctor's orders, given for the purpose of utilizing 
the darkness in the treatment of some particular disease. Apparently 
the beneficial influence of light belongs only to the natural light pro- 
ceeding directly or indirectly from the rays of the sun, so that the 
propriety of artificial light at night must be decided on other grounds, 
it being kept in view that all artificial lights, except electric lamps, 
are potent agents in the contamination of the atmosphere of the room 



BATHING AND CLOTHING INVALIDS. 



177 



Cleanliness of the Invalid. — In all cases of illness, where no 
special reason exists to the contrary, invalids should be washed com- 
pletely twice a day, morning and evening. In doing this, care must be 
taken that the patient is not unduly exposed to cold. Each part of 
the body should be attended to successively, carefully washed with 
soap and warm water, and then dried before the succeeding part is 
commenced. Much care should be taken that the drying is thorough ; 
the towels used for this purpose should be perfectly dry and slightly 
warmed. When any irritation of the skin exists, some dry absorbent 
powder, such as powdered starch, should be dusted on after the drying 
is completed, but the application of the powder should never be used as 
a substitute for the efficient employment of the warm towel. Special 
attention should be given to the folds of the legs and arms, and to the 
recesses behind the ears. After washing and drying the invalid care- 
fully, the nurse should brush and dress the hair, and, when necessary, 
attend to the teeth and mouth ; and the patient should be made general- 
ly as "tidy" as possible. A habitual appearance of comfort and neat- 
ness in the patient will always reflect credit on the nurse. 

In the case of young children, who can be handled easily and dried 
quickly, the ordinary warm bath may be used for ablution, even in 
serious illness. Care must, however, always be taken in using it to 
regulate the temperature of the water accurately with the thermome- 
ter ; the medical attendant will generally prescribe the degree of heat 
most suitable. Where no special reason exists to the contrary, a tem- 
perature of 98° F. is usually eligible. Unless the temperature of the 
room is high, the bath should be given in front of an open fire, as there 
is danger of chill on removal from the bath, resulting from rapid evap- 
oration of the water on the surface of the body. To assist in obviating 
this risk, the child immediately on being taken out of the bath should be 
enveloped in a soft warm towel, and no part of the body should be left 
uncovered until the drying is completed. 

Clothing of the Invalid. — The best material for the dress of chil- 
dren confined to bed is merino or flannel. The qualities sought for in 
the dress are warmth, lightness, and absorptive power, the last quality 
being of at least equal importance with the first. From the human skin 
are constantly thrown off impure secretions, partly in the form of 
vapor, partly in solution and suspension in the fluid perspiration. 
Unless these secretions are properly absorbed, by the clothing, they 
condense and dry upon the surface of the skin, interfering very materi- 
ally with its healthy action. As an absorptive material, merino has 
some advantages over flannel, being more porous, but good flannel 
possesses the three qualities required in reasonable sufficiency. The 
clothes should always be made so as to cover properly the arms and 
legs, as well as the body. In young children it is convenient to have 



I 7 8 HINTS ON NURSING CHILDREN DURING ILLNESS. 

the night-dress long enough to admit of its being tied in the form of a 
bag beyond the feet, when there is a tendency to become uncovered 
through restlessness. 

Whatever the material chosen may be, it is always necessary that 
the dress should be changed with sufficient frequency to prevent it 
becoming disagreeably charged with the secretions emanating from the 
skin. The vaporous element of these secretions may be removed by 
hanging the garment in a current of fresh air, or in front of an open 
fire ; but the matter suspended in the fluid portion can only be extracted 
by careful washing of the clothing. To allow of the frequent removal 
of the gaseous impurities, it is desirable always to have two dresses in 
use at the same time, one for the day and one for the night, and to air 
each well in front of a fire before clothing the invalid in it. As the 
fluid secretions consist largely of water, it must always be borne in 
mind that garments when taken off require to be dried well, besides 
being ventilated thoroughly. 

Food of the Invalid. — Difficulties of feeding do not present them- 
selves to the same extent in the illnesses of children as they do in those 
of adults. For the nutrition of children, in disease as in health, milk 
is the sheet-anchor upon which reliance is placed, and it is very seldom 
that absolute distaste of this food is observed, unless indeed there is 
actual pain in the act of swallowing, from irritability of the throat or 
mouth. In the comparatively few instances in which milk, and foods 
made with milk, are disliked, recourse must be had to chicken-tea, 
thickened with some farinaceous food, preferably one of the malted 
foods ; or those foods may be given made with water, and rendered 
more nutritious by the addition of a small quantity of cream. The 
addition of a little isinglass or gelatine also aids sometimes their 
digestibility, and may render them more palatable. 

[The white of egg whipped up with water, using two eggs to 
the pint, is often acceptable ; or barley-water, made by boiling two 
tablespoonfuls of barley seed in a pint of water for one hour, and 
then straining. This may be flavored with orange.] 

In all cases of serious illness, the nurse ought to keep a written 
record of the amount of food actually taken by the child, noting the 
hour at which each quantity is taken. Such a record is of much value 
to the medical attendant as a guide to the proper treatment of the 
patient. 

III. The administration or application of remedial agents 
forms the third head under which the duties of a nurse have been 
classified. As the administrator of disagreeable medicine, the nurse 
probably presents her least popular aspect to her juvenile patients. 
While many of the other functions of a nurse toward her patients are 
succeeded at once by increased comfort, and are recognized by chil- 



HOW TO GIVE MEDICINES. 



179 



dren as being intended for their well-being and happiness, the effect of 
medicine taken internally is not generally so immediate as to demon- 
strate to the young patients its utility. No doubt much has been effect 
ed of late years in making medicines in a more palatable form, and in 
facilitating their administration ; but even the most skilful pharmacist 
finds it difficult sometimes to disguise the taste of medicines, the use 
of which under certain circumstances may be essential to recovery. It 
is in the administration of such medicines that the influence a good 
nurse acquires over her patient exhibits itself. It is very remarkable 
how quickly even a very young child will learn to appreciate the value 
of a nurse who does her work well, and will undergo unpleasantness if 
assured that benefit is to be derived from it. To acquire this influence 
a nurse must not only know her duties, but must also have gained the 
confidence of her patient by absolute truthfulness. Children are 
most sensitive in this respect, and if a nurse is foolish enough to induce 
a child to take for the first time a disagreeable medicine, on her false 
assurance that it is pleasant, she will create a want of trust which will 
ever afterward diminish her usefulness. Children of from one to two 
years are quite old enough to comprehend, when they are told that 
something unpleasant has to be done to gain future benefit ; and if they 
have not been already ' ' spoilt " in some way, as a rule they will sum- 
mon up their courage to do the disagreeable thing, relying with confi- 
dence on the assurance of the nurse whom they have learnt to trust. 

In the administration of mixtures, perception of the taste is 
much diminished by giving immediately before and immediately after 
the medicine a little milk or water. The milk or water taken immedi- 
ately before the mixture forms a thin coating over the tongue and palate 
which protects them from the medicine, and that following its inges- 
tion carries away any trace which may be left of its taste. This method 
is also particularly applicable to oils, such as castor and cod-liver oils. 
Castor-oil is a medicine which has often to be administered to children, 
and which is usually rather repulsive to them. If the quantity to 
be given is poured into the centre of a little milk in a glass, and some 
water taken immediately before and after, the taste of the oil will often 
not be perceived at all. Cod-liver oil is often rather liked by children, 
when only a small quantity is given at first, and gradually increased ; 
when it is disliked, it may be given similarly to castor-oil, or a little 
orange wine may be used a3 a vehicle in place of milk. 

Powders are, as a rule, best given mixed with a very little water 
in a spoon. If small, they may be placed in the middle of a little jelly, 
or may be mixed with some sugar and taken on the tongue dry, some 
water being swallowed immediately afterward. Powders are occasion- 
ally enclosed in gelatine capsules or in wafer cachets, but it is difficult 
to induce children to swallow these whole, and if broken the taste of 



180 HINTS ON NURSING CHILDREN DURING ILLNESS. 

the powder is perceived at once. This remark applies also to the com- 
pressed tabloids which have been introduced within late years, and to 
medicines made up in the form of coated pills. As a rule, there is no 
objection to giving a child some harmless sweet after taking medicine, 
and if its taste is consulted in this matter, the inducement will often 
be sufficient to make it take disagreeable medicine without much 
reluctance. 

External applications are made use of to a very considerable ex- 
tent in the treatment of disorders in children, being employed for four 
distinct objects. In the first place, they are used for the purpose of 
increasing or diminishing the temperature of any part of the body ; in 
the second, they are applied in order to maintain the moisture of any 
part ; thirdly, what are called counter-irritating applications are direct- 
ed to the relief of pain and inflammation ; and lastly, medicated prep- 
arations are applied to the skin in order that they may be absorbed, 
and may thus exercise their special medical effects. In practice it is 
usually convenient and advantageous to employ applications which 
combine two or more of these objects, and most of those described will 
be found to do this. This combination which is most frequently called 
for in illness in children is the application of heat associated with moist- 
ure, a combination usually effected by the use either of warm fomen- 
tations, or of poultices of various kinds. 

Warm Fomentations. — A piece of flannel about four times the 
size of the surface to be covered with the fomentation is taken, and 
folded twice upon itself, so as to afford a pad of four thicknesses of 
flannel, of the required size. This pad is laid upon a strong towel, 
which has been placed across an empty basin, and boiling water is 
poured over it until the flannel is saturated, any surplus water running 
off through the towel into the basin beneath it. Each end of the towel 
is then taken hold of and twisted, so that the flannel is wrung out 
within the twists of the towel. The towel is then untwisted, and the 
flannel taken out and applied to the invalid, after the nurse has satis- 
fied herself that it is of proper temperature. The flannel is immedi- 
ately covered with a piece of waterproof sheeting or of oiled silk, to 
prevent evaporation and consequent rapid cooling, and to protect the 
dress of the patient from moisture. "When applied efficiently in this 
manner, flannel often affords great comfort, and is preferable to poul- 
tices on account of its being cleaner, as well as lighter in weight. On 
the other hand, it does not retain its heat so long as a well-made poul- 
tice, and requires consequently to be more frequently replaced. 
Speaking generally, moist applications of warm flannel, to be thorough- 
ly effective, should be renewed every half-hour. They ought always 
to be prepared in the immediate vicinity of the patient, otherwise 
they are apt to cool rapidly in being carried. 



POULTICES. 181 

A material called spongio-pilin, which consists of a thick felt 
coated on the outside with a waterproof layer, is occasionally employed 
as a substitute for flannel and waterproof sheeting, being saturated with 
hot water, and pressed before being applied. Ii has no advantages over 
flannel, except perhaps that of convenience, while it does not retain its 
heat so long, and is somewhat apt to render damp the clothes of the 
invalid. 

Poultices may be made with a variety of materials, linseed meal, 
oatmeal, bran, starch, rice, and bread being all made use of under 
different circumstances. The material most commonly employed for 
the purpose in England is linseed-meal, and the detailed description of 
poultice-making which follows applies specially to this material ; oat- 
meal and bran poultices,' however, are made in an exactly similar man- 
ner. A short description of other poultices will be added, and their 
special uses will be mentioned. 

Linseed Poultices. — To make an ordinary linseed-meal poultice 
well, it should be made quickly ; and to enable one to do this, all the 
materials must be ready before the actual process of making commences. 
To begin with, there must be something as a basis on which the poul- 
tice is to be spread. In home nursing, the material most commonly 
made use of is old linen or cotton, a piece of which is cut, rather larger 
than the size of the poultice it is intended to receive. Thick brown 
paper does fairly well for the purpose, but the edges are apt to be felt 
slightly rough by the patient. In some hospitals ordinary tow is used. 
A bowl or basin, proportioned in size to the poultice to be made, is 
also necessary, and a wooden or metal spoon for stirring the poultice 
properly. A little hot water in another basin or cup is also desirable, 
and a kettle filled with absolutely boiling water must be available. 
Everything being now prepared, a certain quantity of boiling water 
is poured into the basin, the quantity depending upon the size of poul- 
tice required, and being learned only by experience. The nurse then 
takes the spoon in one hand, and some linseed meal in the other, and 
1 ts the meal fall rapidly into the water, which she stirs continually 
with the spoon. Enough meal is added to make the poultice of fair 
consistency, and the mixing should be completed when the whole of 
the meal has been added. The mixture thus made is then spread on 
the linen or cotton prepared for it, and the surface smoothed over by 
the spoon, dipped into the hot water in the other basin or cup. The 
edges of the linen or cotton are then doubled over so as to cover the 
edges of the poultice, which is now ready for use. Nurses differ to 
some extent in the thickness with which they spread the poultice, and 
one or two considerations have to be kept in view in deciding the mat- 
ter. The more thickly it is spread, the longer it will retain its warmth, 
but its weight will of course be greater ; and if the poultice is at all a 



182 HINTS OX NURSING CHILDREN DURING ILLNESS. 

large one. and placed on a part -where the weight will be felt, as on the 
front of the chest, the weight may be of some importance. In children, 
indeed, if there exists any difficulty of breathing, the pressure of a 
heavy poultice on the chest may do material injury. As a general rule, 
about half an inch will be found a convenient thickness, if the poultice 
is to be placed in a position where pressure will not be injurious ; when 
the poultice is one of exceptional size, or is to be placed on a part where 
pressure may do harm, a thickness of a quarter of an inch will be suffi- 
cient. Linseed-meal poultices should always be applied without any- 
thing intervening between the linseed and the skin. The two best tests 
of a well-made linseed-meal poultice are, that it can be rolled up on 
itself and unrolled again without any damage to its surface, and that 
it can be applied to the skin, and afterward removed, without any of the 
poultice remaining adherent to the skin. Sometimes, when the linseed- 
meal is rather dry, a little olive or linseed oil will require to be added 
to the poultice after it has been thoroughly mixed, in order to attain 
the degree of perfection indicated. It should be remarked that com- 
monly two different preparations of linseed are sold under the name of 
iinseed-meal. The first kind is sometimes called also "'crushed lin- 
seed," and is simply the pure linseed crushed and bruised into a condi- 
tion of meal ; the other is a powder made by grinding linseed cakes 
(which are commonly called oil-cakes), from which the linseed-oil has 
been expressed by pressure. The former is naturally the softer and 
more oily, but is apt to ferment and become somewhat rancid ; when 
used for poultices, care should be taken to obtain it quite fresh. The 
second is the more eligible preparation ; and when it has been rendered 
too dry by excessive pressure to extract the oil, the addition of a little 
fresh linseed-oil to the poultice removes the defect. Poultices retain 
their warmth considerably longer than flannel wrung out of hot water, 
and accordingly do not require to be replaced so frequently. If well 
made and of considerable thickness, especially when protected on their 
outside by flannel, or wool tissue, or thin waterproof sheeting, it will 
not usually be found necessary to change them more often than once 
every three hours, and sometimes they will retain their warmth even 
longer than that period. 

Bread Poultices are best made from the crumb of stale bread. 
which should be powdered and stirred into boiling water, the dish in 
which it is made being afterward allowed to stand in boiling water 
for five minutes, to allow the bread-crumb to swell thoroughly. They 
are usually employed only when very small poultices are required, 
being especially useful for amplication to the eyelids in inflammatory 
conditions. Cnlike linseed poultices, bread poultices, may be made in 
bulk and kept warm or reheated, so that they are convenient for use 
when very frequent change of the poultices is considered desirable. 



HOT AND COLD APPLICATIONS. 183 

They should always be applied directly to the skin, without any inter- 
vening tissue. Occasionally milk is made use of in their preparation 
in place of water, increasing to some extent the soothing qualities of 
the poultices. 

Starch Poultices are used mainly for allaying irritation of the 
skin in various skin diseases. The starch is powdered and mixed with 
cold water, and then boiled for a few minutes until a proper consistence 
is attained. It is spread for use upon some linen or cotton, and applied 
warm directly to the skin. 

Application of Dry Heat. — Heat without moisture is not unfre- 
quently employed for the purpose of maintaining or restoring the 
natural temperature of any part of the body, when the circulation has 
been locally enfeebled, or when any chill has been experienced. It is 
most conveniently applied by means of flannels heated at a fire, or 
rolled round a hot brick, or a bottle filled with water ; or by the use of 
small bags filled with sand or salt which has been heated in an oven, 
previously to being poured into the bags. In making such applications, 
great care must be taken that the amount of heat is not sufficient to do 
any injury. The nurse should always test the temperature with her cheek 
or with the back of her hand, bearing in mind that the heat takes some 
little time to penetrate through a few thick folds of flannel. Especial 
care is requisite in cases of disease of the nervous system involving 
paralysis, in some instances of which the reaction to heat is excessive, 
while the sensitiveness is diminished or lost, so that severe injury may 
result from excess of heat while the invalid is quite unconscious of any 
discomfort. 

Cold applications are very frequently employed both for the 
relief of pain, and in the treatment of local and general diseases. The 
simplest way of applying cold to any part of the body is by placing 
upon it thin cloths wetted with cold water, and changed as often as 
they become either warm or dry. Such applications cool the part on 
which they are placed in two different ways. In the first place, the 
water by which they are saturated is cooler than the skin to which they 
are applied, and when placed in contact with it absorbs some heat 
from it. In the second place, water exposed to air evaporates rapidly, 
and this process of evaporation is accompanied by considerable abstrac- 
tion of heat from surrounding parts, and especially from the part with 
which the water is in contact. It will be obvious, therefore, that to 
utilize both these methods of cooling the part, the cloth which is 
saturated with the water must be thin, and must be freely exposed to 
the air, so as to admit of rapid evaporation. For ordinary purposes 
part of a linen handkerchief folded double answers very well ; and the 
changes must be made as frequently as it is found to become warm, 
and thus to lose its power of abstracting heat directly from the part. 



184 HINTS ON NURSING CHILDREN DURING ILLNESS. 

It will not unfrequently be found that the changes have to be made so 
often as to become tedious both to the invalid and to the nurse, and 
some other device has to be adopted to attain the same result. It will 
be perceived that the same object would be achieved if a constant 
supply of fresh cold water could be conveyed to the folded handker- 
chief, the water as it becomes warmer being removed by evaporation, 
and replaced by the fresh supply. This is not difficult to arrange by 
meahs of a thin skein of cotton or worsted, and a small jar or jug to 
hold the water. If the jar be suspended beside the patient a little 
higher than the part to be kept cool, filled with cold water, and a skein 
of worsted or cotton be carried from it to the folded handkerchief, 
immersed at one end in the water in the jar, and in contact with the 
handkerchief at the other end, a constant stream will flow from the jar 
to the handkerchief, which will be thus kept always wet. The volume 
of the stream will depend mainly on the thickness of the skein, and 
partly on the difference of height between the jar and the handkerchief ; 
by altering these one is able to regulate satisfactorily the amount of 
water supplied, so that the bed of the patient does not become moist- 
ened. It is well, however, for a careful nurse always to have a small 
piece of covered mackintosh sheeting under any part to which cold 
water is to be thus applied. 

When a greater degree of coldness is demanded, the water may be 
artificially cooled by the addition of ice, or of some salt which abstracts 
heat from the water during solution, such as chloride of ammonium oi 
nitrate of potash. Or the same result may be attained by the addition 
of some fluid to the water which will render the process of evaporation 
more rapid, such as methylated spirit or vinegar. A still further 
degree of cold can be produced in any part of the body by the applica- 
tion of melting ice, enclosed in some form of waterproof bag. When 
ice is melting into water, the water formed remains at a temperature 
just above 32° F., known as the freezing-point, until every fragment 
of ice has melted ; so that if ice is broken in pieces and placed in a bag, 
a very uniform low temperature is maintained as long as the process of 
melting is proceeding. India-rubber bags for the purpose of contain- 
ing ice, and shaped according to the part to which they are intended to 
be applied, are obtainable from surgical instrument makers ; but it is 
not difficult for an intelligent nurse to improvise a bag which will be 
quite as effective as those sold for the purpose. In some cases an 
ordinary sponge-bag will suit very well, the mouth of it being carefully 
tied round a large cork, after the ice has been put into it. Very con- 
venient ice-bags can be made by the nurse, of any size and shape re- 
quired, out of thin gutta-percha tissue sold by all chemists, the edges 
being cemented together by the application of chloroform. The gutta- 
percha tissue is double, and cut to the size and shape wanted ; the free 



THE USE OF ICE. 185 

edges are then turned over, and are made to adhere by brushing a little 
pure chloroform quickly along them, and pressing them until they ad- 
here firmly together. A very little practice will give the necessary 
quickness and neatness in making such ice-bags, and they will be found 
veiy convenient and useful. The gutta-percha tissue used for the pur- 
pose should always be good and comparatively new, otherwise there 
will probably be found in it some minute holes which will leak un- 
comfortably as the ice melts. 

Ice is generally bought in large blocks, and it will fall to the nurse 
to break these blocks into small lumps, suitable for introduction into 
the bags. This is best done with a small hammer and some pointed 
instrument, such as a bradawl or a shoemaker's awl. By pressing the 
point, of the awl on the ice, and giving a smart rap on its head with the 
hammer, the block will be found to split quite easily into small frag- 
ments. Until the ice is required, it is best left in the original large 
blocks, melting much more slowly thus than when broken up. The 
blocks should be rolled up in flannel, and placed in such a position that 
the water resulting from their melting is able to drain away as quickly 
as it is formed. A good plan is to tie some flannel or a piece of blanket 
loosely across the top of a pail or deep basin, to place the ice in the 
hollow of it, and to cover it over with another piece of the same 
material. At first sight, it may appear rather unreasonable to "keep 
ice warm" in this way ; the ground, however, for doing so is practically 
the same as that on which flannel is recommended to be used for cloth- 
ing. Flannel is a bad conductor of heat, and when used for clothing 
it is intended to prevent the escape of heat from the body ; in the case 
of ice it is intended to prevent the admission of heat to the ice, in both 
cases equally impeding the transmission of heat. 

In certain cases of essential fever, and more particularly in scar- 
let fever and typhoid fever, when the temperature tends to become 
dangerously high, it is usual to attempt its reduction by the application 
of cold to the whole body of the patient, and it is necessary for a nurse to 
know how to carry out this treatment when ordered by the physician 
in attendance. Some reduction of temperature, and considerable gain 
in comfort to children suffering from febrile illness, is obtained by 
frequent sponging with cold water, to which is sometimes added with 
advantage a small quantity of vinegar. The effect of the sponging in 
diminishing temperature is increased if the patient is not dried for two 
or three minutes after the sponging, the evaporation from the skin 
being useful in promoting the abstraction of heat. 

When cold sponging is not sufficient to lower the temperature, a 
fact to be ascertained by the use of the clinical thermometer before and 
after its employment, recourse is often had to packing in a sheet wrung 
out of cold water. To carry out this treatment satisfactorily, the bed 



1 86 HINTS ON NURSING CHILDREN DURING ILLNESS 

of the patient, or where possible, another bed in the same room, must 
be specially prepared by having a waterproof sheet, with a blanket 
above it, spread over the sheet upon which the invalid usually lies. 
While the patient lies on this, covered with another blanket, a sheet is 
taken and soaked in cold water, wrung gently so as only to press out 
the excess of water, and then folded round the invalid, underneath the 
blanket with which he is covered. Reduction of temperature is observed 
by occasional use of the clinical thermometer, and when the sheet be- 
comes warm by contact with the body, it is replaced by another treated 
in the same way ; this is repeated until the required reduction in tem- 
perature is attained. The patient is then dried, and the bed restored 
to its original condition j or, where a second bed has been made use of, 
he is carried back to the one from which he was taken. It is not 
usually considered desirable to take advantage of the cooling effects of 
evaporation in this treatment ; the reduction of temperature is effected 
almost entirely by the actual contact of cold water with the patient. 

The application of simple moisture, independently of increased 
or diminished temperature, is frequently desirable in the treatment of 
some internal diseases, as well as in the case of external wounds. This 
is usually effected by means of what are termed compresses, which 
consist of linen or cotton or lint folded in one or two thicknesses, dipped 
in warm water, and covered with oiled silk or gutta-percha tissue. 
If lint, which is the best of the three materials mentioned for the pur- 
pose, is employed, it is generally sufficient to use it of only double 
thickness. The doubled lint is cut to the size required for the com- 
press, and a piece of oiled silk or gutta-percha tissue is cut, so that its 
edges overlap in every direction the lint by from a quarter to half an 
inch. The lint is then soaked in warm water, and laid on the oiled silk 
or gutta-percha tissue, the overlapping edges of which are folded over 
so as to cover in the edges of the lint, and if necessary stitched in posi- 
tion. The compress is then applied to the part desired, and secured in 
its place by a thin flannel or calico bandage. Compresses of this kind 
are very valuable in many cases of inflamed throat, being applied from 
ear to ear under the chin, and secured by a bandage over the head. 
When the compress is used for application to a wound, it is better not 
to double the edges of the gutta-percha tissue or oiled silk inward ; 
but having cut the lint to the exact size of the wound, to make the 
tissue overlap a little all round, the overlapping part resting on the 
healthy skin around the wound. Compresses do not require frequent 
changing ; if the oiled silk is properly applied so as to completely 
cover the lint, they will remain quite moist for more than twelve hours. 
Treatment by counter=irritation is founded partly on the scien- 
tific knowledge that irritation excited on an external part of the body 
relieves the congestion of blood which accompanies inflammation in a 



STIMULATING LINIMENTS AND PLASTERS. 187 

neighboring internal part, by diverting a portion of the supply of 
blood directed to it, and partly on empirical experience that the dis- 
comfort and pain of internal inflammation is relieved by external irrita- 
tion. The empirical experience will be obvious to any one who has 
applied whiskey or iodine to the gum for the relief of incipient gum- 
boil. The amount of irritation which it is desirable to apply in any 
particular case to the external surface, will vary with the extent and 
character of the internal inflammation which it is intended to affect 
and remedy ; and to some degree also with what the patient is able to 
bear. As a general rule, it may be stated that the greater the extent of 
skin over which it is intended to apply the counter-irritant, the less the 
amount of irritation set up ought to be. A very mild mustard poultice 
may be used to cover the vdiole of the chest and back of an invalid, 
while a pure mustard plaster would only be applied to a small part of 
the chest at one time, and that part would be allowed to recover to some 
extent, before the plaster was repeated on another part of the skin. 
Simple counter-irritation in children is generally effected either by 
friction with some stimulating liniment, such as ammonia or turpentine 
liniment, or by the application of an irritant plaster, such as that 
made of mustard or capsicum. 

Stimulating Liniments. — Some little skill and practice are re- 
quired before a nurse can make effective use of liniments which are in- 
tended to be applied by friction. Much the most effective means of 
using them is by rne uncovered hand. A little of the liniment is poured 
into the palm of the hand very slightly hollowed, and, being conveyed 
to the part to which it is to be applied, is rubbed into the skin by gentle 
but firm and unifoim friction. This friction may either be in a circular 
direction or upward and downward, according to the part where the 
application is made ; in some cases, friction only in one direction is 
permissible, and then the hand must be lifted from the skin to return 
to the starting-point. On the chest and abdomen circular friction is 
generally best, on the lower part of the back the friction should be up- 
ward and downward, and on the legs and arms usually only up- 
ward. The amount of liniment to be rubbed in, and the length of 
time which is to be devoted to the rubbing, must vary so much with 
individual cases that no general rule can be given. As the friction has 
usually a pleasant and somewhat soothing effect, the patient is not 
likely to complain of some time being occupied by it ; but unless a 
nurse is practised in the process, she will find the fatigue considerable 
after a few minutes. 

Mustard plasters are prepared by spreading on some base, such 
as brown paper or thick linen or cotton, or, what is best of all, a few 
layers of tissue paper, a thin coat of mustard which has been mixed 
with water, exactly as mustard is commonly prepared for use as a con- 



1 88 HINTS OX NURSING CHILDREN DURING ILLNESS. 

diment. Care must be taken to elicit the strength of the mustard by 
thorough mixing ; and it should be spread uniformly to the size re- 
quired, with the thickness of about one-tenth of an inch. The edges 
of the base should then be turned over, to prevent the escape of any 
mustard, and the surface should be covered with one layer of tissue 
paper, or of very thin linen or fine muslin, before the plaster is applied 
to the skin. Usually from fifteen to twenty minutes' application will 
produce the desired amount of counter-irritation. 

For the application of counter-irritation, in combination with the 
soothing and curative effects of heat and moisture, it is usual to make 
use of either mustard poultices, or turpentine stoups, made of warm 
moist flannels sprinkled with turpentine. Spongio-piline wrung out of 
hot water and sprinkled with turpentine is also an excellent appliance 
for carrying out this treatment. 

flustard Poultices are generally made of either linseed-meal or 
oat-meal, combined with mustard in varying proportions. For chil- 
dren a common proportion is one-fourth of mustard to three-fourths of 
meal ; a poultice of this strength will usually be borne well for an hour 
at a time, and will act as a very efficient counter-irritant. For young 
babies a proportion of one-fifth of mustard will generally be quite 
sufficient. The most usual method of making them is to mix the 
mustard and meal first, and then to add boiling water with constant 
stirring until the poultice arrives at the proper consistency. This is 
not, however, the best way, as mustard does not yield readily the 
essential oil, upon which its strength depends, to boiling water. A 
better way is to mix the mustard well first with cold water, then to add 
the boiling water, and proceed to make the poultice by adding the meal 
as was described in making linseed poultices. Or, in accordance with 
the directions of the "British Pharmacopoeia," the poultice may be made 
first as a linseed poultice, and the mustard then added and mixed well 
with much stirring. The central fact to be kept in view is that the 
strength of mustard has to be developed by intimate mixture with 
water ; and that the greater part of the effect of it is lost, unless 
care be taken in its preparation. Mustard poultices should be applied, 
like linseed poultices, directly to the skin of the invalid. 

Turpentine stoups are made by sprinkling warm moist flannel 
prepared as has been described on page 180, with a small quantity of 
pure turpentine. The quantity will vary with the size, and with the 
degree of irritation desired ; it will generally be found that half a 
teaspoonful, sprinkled carefully ^ver a square foot of flannel, will be 
sufficient to produce within an hour decided redness of the skin, with 
some feeling of heat and irritation. Care must be taken that the tur- 
pentine is distributed equally over every part of the surface, and thai 
the flannel is not allowed to become cool before being applied. After 



LOTIONS FOR EYES, EARS AND THROAT. 189 

the amount of irritation desired has been attained, it may be kept up 
for an indefinite time by further applications of stoups prepared with a 
diminished quantity of turpentine, or by a succession of simple warm 
fomentations. 

"When spongio=piline is employed it is sprinkled with turpentine 
exactly in the same way as the flannel, after being dipped in very hot 
water and pressed. 

Lotions are usually employed in a manner similar to the water 
used for the purpose of maintaining simple moisture, as described on 
page 186, the lint being saturated with the lotion, and covered over 
with oiled silk or gutta-percha tissue ; sometimes they are simply 
dabbed on and allowed to dry. In the application of lotions to the eyes, 
it is most convenient to use a small piece of absorbent cotton-wool, 
which is saturated with the lotion, and used like a sponge for bathing 
the e} r es. It is usually necessary that some of the lotion should go in- 
side the eyelids to be thoroughly effective ; this is easily managed by 
drawing downward the lower eyelid with the finger, and at the same 
time squeezing the cotton-wool a little, so that a few drops of the lotion 
fall from it into the eye. No injury can possibly result from drawing 
down the eyelid in this way, if care is taken to rest the finger not on 
the eye itself, but on the ridge of bone which projects below the eye. 

The interior of the ears has occasionally to be syringed with warm 
water, or with prescribed lotions. The most convenient syringe for 
the purpose is one made of a small india-rubber ball, with a glass or 
ivory ear-piece attached. This is filled by immersing the end of the 
ear-piece in the water or lotion, and after compressing the ball to empty 
it of air, allowing it to expand so as to draw into it the fluid which is 
to be employed. The ear -piece is then directed to the entrance of the 
ear, but not pressed into it, and the ball being compressed, the fluid is 
injected into the ear, running out again after it has reached the drum 
of the ear, at the farther end from the external opening. A small bowl 
should be held under the ear to receive the returning fluid. In very 
young children it will be found most convenient to syringe their ears 
when in their bath, and then no bowl need be used to receive the re- 
turning injection. 

Applications to the interior of the throat are best made with a 
camel's-hair brush fitted with a straight handle. If the child has been 
taught to open its mouth property, very often it will not be necessary 
to use any means for depressing the tongue ; if, however, the throat 
cannot be seen on account of the tongue, the handle of a teaspoon 
should be used to press it downward. The child should be placed 
facing a window, while the nurse takes the brush in one hand and the 
teaspoon in the other, and immediately on depressing the tongue, paints 
with the solution the part of the throat which requires attention. The 



190 



HINTS ON NURSING CHILDREN DURING ILLNESS. 



essential qualities for success in this little operation are quickness and 
neatness. If the brush is soft, there is no risk whatever of doing any 
injury to the throat ; and the more quickly the painting is effected, the 
less will the child usually resent the process. 

Precaution Relating to Infectious Diseases. — On the occurrence 
of infectious disease in a house, it sometimes falls to the duty of the 
nurse to make arrangements for the isolation of the patient, in order 
to prevent the spread of the infection. To be effective, isolation must 
always be thorough and complete. The patient and the nurse should 
be allotted one or two rooms, or, when possible, a whole floor of the 
house ; and no one else in the house should be permitted to enter these 
rooms on any pretext whatever. When it can be managed, the rooms 
should be separated from the rest of the house by a large sheet of 
washable material, calico or cotton being the most suitable, which 
should be kept constantly moist with water mixed with some disin- 
fectant fluid, such as a weak solution of carbolic acid. The solution 
should be of the strength of about one part of the disinfectant fluid to 
thirty parts of water. When the rooms cannot be isolated in this way. 
a similar sheet should be fastened outside the door of each of the rooms 
used for the patient and nurse. As the nurse must leave the isolated 
rooms once or twice daily for a walk and for other necessary purposes, 
a washable dressing-gown or other garment, which is large enough to 
completely envelop her, should be placed just outside the isolated 
area ; and this should be put on by the nurse each time she leaves the 
rooms, and put off again before she enters them. When leaving the 
house for her daily walk, the enveloping garment should accompany 
her to the outside door of the house, and being left there, should be 
put on again on her return. Every nurse who is in constant attendance 
on a case of infectious disease should be made to take a walk of at least 
an hour daily. If this is not insisted upon, her health is exceedingly 
likely to fail, and she may break down entirely at the critical period 
when her services may be in urgent request. For the purpose 
of keeping the air of the house as pure as possible, reliance must be 
placed on the most thorough ventilation attainable. On the floor below 
where the patient is, doors and windows should be kept widely open 
throughout the day, and; so far as the season will permit, during the 
night also. The windows of unoccupied rooms on the same floor as the 
patient shpuld also be utilized for ventilation. 

Disinfectants in Infectious Diseases. — No confidence is to be 
placed on the use of disinfectants for the purpose of maintaining the 
atmosphere pure, and destroying infectious germs. Currents of pure 
air, and as much sunshine as possible, are the only reliable disinfectants 
of the air of inhabited houses. Disinfectant and antiseptic fluids can 
only be relied on when used in solutions of proper btrength for wash- 



THE USE OF DISINFECTANTS. 191 

ing, and for mixing with excreta before being carried out of the room, 
but they cannot be added to respirable air in sufficient proportion to 
have any real disinfectant power. All washable clothing, night-dresses, 
and bed-linen should be placed in linen or cotton bags when dirty, and 
should be boiled thoroughly before being sent to be washed, or, where 
possible, should be retained in one of the isolated rooms until the illness 
is over, and then sent away for disinfection. Plates, cups, and saucers, 
and other articles containing food should be placed by the nurse, after 
the food is consumed, in a large basin or small tub outside the door of 
the sick-room, and completely immersed in a solution of carbolic acid 
of the strength of one part in twenty of water. 

Water which has been used in washing the patient, and all excreta, 
should be completely disinfected by the addition of carbolic acid in a 
proportion of about one in ten parts, before being removed from the 
room. 

The one risk of spreading the infection, if all the precautions 
mentioned are rightly observed, lies in the passage of the nurse through 
the house when going to and returning from her daily walk. This is 
a risk which must be incurred, but care should be taken to minimize it 
as far as possible. Before leaving the rooms, the nurse should wash 
her hands and face carefully. She should walk straight out of the 
house without stopping to speak with any one, and any conversation 
she may desire should take place after her return from the walk, be- 
fore entering the invalid's rooms. 

When the illness is over, and the risk of personal infection from 
the invalid gone, he should be taken, in as little clothing as possible, 
to a room free from infection, given a complete bath of water with 
carbolic acid, of the strength of about one in forty, the hair and 
the head being washed as well as the body, and then clothed in 
garments which have not been exposed to the risk of infection. 
The clothing in which he was brought out of the room should 
be returned to it, and left there until room and clothing are subjected 
to thorough disinfection. This is usually undertaken by the local 
sanitary authorities. 

It is desirable to repeat and emphasize the fact that disinfectants 
can never occupy the place properly filled by fresh air and perfect 
cleanliness ; they can only at best act as adjuncts, giving some ad- 
ditional security after every possible care has been taken in all other 
respects. 

Abuse of Disinfectants. — In the nursing of non-infectious cases 
the use of antiseptics and disinfectants is generally unnecessary, and is 
not unfrequently a cloak for carelessness in cleanliness. It may be 
laid down as a general rule, that the better a nurse is, the smaller 
amount of disinfectants and antiseptics she will employ. 



CHAPTER XVII. 

Some Minor Troubles of the Earlier Months or Infant Life. 

Separation of Stump of Umbilical Cord; Occasional Ulceration; Treatment; 
Hernia at Navel ; Management; Inflammation of Breasts ; Desquamation 
of Skin; Red-Gum; Jaundice; Yellow-Gum; Thrush: Its Cause and 
Treatment; Diarrhoea; Its Causes and Treatment; Erythema and Inter- 
trigo; Sand or Gravel; Constipation: Its Treatment; Inflammation of Eye- 
lids; Method of Applying Lotions to Eye; Closure of Lachrymal Ducts; 
Vaccination. 

Separation of Umbilical Cord.— In connection with the natural 
process of the separation of the stump of the umbilical cord soon after 
birth, some departures from the normal course are occasionally en- 
countered. When the separation proceeds healthily the stump shrinks 
and dries in two or three days, a very fine line of ulceration is observed 
at its junction with the skin of the abdomen, and when it drops off on 
the fifth or sixth day after birth, a small circle of healthy skin, with 
a minute depression in the middle, is seen in the centre of the abdomen, 
where the cord was previously attached. Sometimes the stump, in- 
stead of drying, becomes more moist and smells somewhat unpleasantly, 
indicating the existence of decomposition. When this occurs the sep- 
aration usually progresses more slowly, and the line of ulceration be- 
comes wider and more obvious, and is accompanied not unfrequently 
with an appreciable discharge of unhealthy matter. The best treat- 
ment for this condition is frequent powdering of the stump with some 
antiseptic dry powder, such as boracic acid mixed with an equal quantity 
of oxide of zinc or of powdered starch. If such a powder be dusted 
well twice daily over the stump and the skin in the vicinity of its 
attachment to the abdomen, the decomposition is usually arrested, and the 
separation proceeds satisfactorily. If, after the separation of the stump, 
a small ulcerating surface is left behind, this should be dusted twice 
daily with the same powder. Frequently after the separation of the 
stump, the part of the surface of the abdomen to which it was attached 
is covered over by a fold of skin, from beneath which a little discharge 
may be seen to exude, giving rise to the supposition that the matter is 
coming actually from within the navel. This is never the case ; when 

discharge of this kind is seen, the source of it will always be found, on 

193 



HERNIA AT THE NAVEL. 



193 



stretching- the skin and distending the navel, in a small ulcerating sur- 
face made obvious by the distention. Very frequently this surface 
takes the form of a small polypus about the size of a small pea, pro- 
jecting from the central depression of the navel, keeping up the dis- 
charge, and causing irritation of the surrounding skin encircling the 
navel. In treating this condition with antiseptic powder, care must be 
taken that the powder reaches the ulcerating surface. It is not 
sufficient simply to dust the powder over the skin of the abdomen ; the 
navel must be distended, and the ulcerating surface brought to view 
before the powder is applied, so that the application may be efficiently 
made. When the use of the powder for a few days does not result in 
complete cure, it may be necessary to touch the surface twice daily 
with some astringent, such as a piece of blue stone (sulphate of copper) ; 
sometimes, when the polypoid growth is large, it is desirable to re- 
move it by tying a thread tightly round it, or by snipping it off with 
a pair of scissors. 

Umbilical Hernia. — In infancy there is often a strong tendency to 
the development of hernia at the navel. The wall of the abdomen at 
that point is often thin and elastic, and when an infant cries lustily, a 
small part of the bowel is sometimes pushed through the weakened 
wall, projecting to the size of a large thimble in the middle of the 
abdomen, and covered only by thin semitranslucent skin. This form 

of rupture may appear 
at any time during the 
first year of life, but is 
much more common in 
the earlier weeks. Its 
presence should not ex- 
cite anxiety, as, when 

Pig. 27. 



Fig. 26. 




UMBILICAL KANDAGK i'OK YOUNG INFANTS. 




treated by the application of the belt de- 
scribed in Chapter XV., recovery in time is 
the invariable result ; but care should al- 
ways be taken in washing the infant that no 
injury is done to the projecting hernia. 
When it is large, and appears immediately 
on the removal of the belt, it is well to have umbilical bandagb. 
a special india-rubber belt for use during the time that the infant is 
being bathed, replacing this by the ordinary belt when he is removed 
from the bath and dried. 

Inflammation of the Breasts of Infants.— Infants, both male and 
female, are somewhat apt to suffer from slight inflammation of the 

breasts within a few days after birth. The nipples and the siiuiU 

7 



194 



EARLIER TROUBLES OF INFANT LIFE. 



glandular tissue beneath them become somewhat swollen, reddened, 
and tender to touch, and occasionally there is exudation of a little 
fluid having some of the properties of milk. The disturbance rarely 
lasts beyond one or two days, and only exceptionally calls for any 
treatment. "When the swelling is considerable, gentle rubbing with 
olive oil [or Magnetic Ointment] is useful, and will be found to aid 
the reduction. Ignorant nurses sometimes fancy that it has some con- 
nection with the development of the gland for the process of nursing 
in later life, and in female children accordingly "assist" by manipula- 
tion which not unfrequently results in severe inflammation, sometimes 
followed by abscess. The exact cause of the glandular disturbance is 
not known, but its occurrence in male children as well as in female 
seems to negative the hypothesis of the nurses described above. On the 
other hand, mothers who are not aware of this peculiar tendency to 
irritation in infant life are occasionally apt to attribute its occurrence 
to carelessness of the nurse, and to hold her responsible for what is 
really a somewhat inexplicable natural phenomenon. 

Desquamation of Skin. — Reference has already been made to the 
desquamation or casting of the skin which follows within two or three 
weeks of birth. The process is sometimes very obvious, the skin peel- 
ing off in very apparent shreds ; sometimes, on the other hand, it is so 
gradual and slight as to be quite unnoticed except by a careful 
observer. Frequently it is accompanied by some irritation of the skin, 
which shows itself in the development of small red spots scattered over 
the body. These spots are known popularly as red=gum, more 
scientifically as strophulus. They vary in size from a pin's head to a 
split pea, or even more, and project somewhat from the skin, forming 
up-raised pimples. Sometimes, when the eruption is severe, there is 
a little watery fluid on the points of some of the pimples, giving them 
the appearance of small vesicles. These pimples are generally scattered 
over the greater part of the body and limbs, and last for a few days, 
gradually fading away. It is very seldom that they seem to be a 
source of discomfort to the infant, and as a rule no treatment what- 
ever is required. *%*> 

During the first week of life many infants exhibit symptoms of 
jaundice, the skin and the white part of the eyes becoming stained to 
a deep yellow color. The cause of it is not always apparent, but in some 
cases at least it seems to be due to disturbance of the stomach from 
fluids swallowed during the process of birth. Beyond sometimes 
affecting for a few days the desire for food, this form of jaundice does 
not appear injurious, and usually disappears in from a week to ten 
days. When the eruption described above as red-gum makes its 
appearance while an infant is jaundiced, the spots or pimples appear 
of a more or less yellowish color ; and the popular names of yellow- 



THRUSH OF MOUTH AND THROAT. I95 

gum has been applied to this combination of jaundice and irritation of 
the skin. No treatment is required for this form of jaundice but if 
the infant is being fed artificially some difficulties of digestion may 
present themselves, and call for attention, and modifications of feed- 
ing such as have been indicated in Chapter XIII. It will occasionally 
be observed that during the existence of the jaundice the urine of the 
infant is very high-colored, and stains deeply the napkins. This is a 
natural result of jaundice, when present to any extent, and need not 
give rise to any anxiety, so long as the infant seems in other respects 
well, and maintains its appetite. Jaundice as described above is of 
short duration, never probably lasting more than a fortnight. If it 
continues for a longer period than this it is likely to be due to some 
more serious underlying condition, and demands medical attention 
and skill. 

Thrush is a peculiar form of inflammation of the mouth and 
throat affecting most commonly infants, but sometimes also older chil- 
dren, and even adults when in a weak state of health, characterized by 
the presence of a minute fungoid growth of a yellowish-white color. 
If the interior of the mouth of an infant suffering from thrush be ex- 
amined, the tongue, the interior of the cheeks, the gums, and occasion- 
ally the throat, will be observed to be dotted over by small whitish 
patches, like small flakes of curdled milk. Each little patch is sur- 
rounded with a circle of deepened red color, and little ulcerated 
points may be noticed here and there, where the fungoid growth has 
separated from the interior lining of the mouth. Sometimes the patches 
of white growth are so numerous that they coalesce, and unite into a 
continuous membrane lining a considerable part of the mouth. When 
the patches are small, and the surrounding circles of darker red not 
very marked, they may be easily mistaken at first sight for flakes of 
curdled milk ; but the distinction is made without difficulty by attempt- 
ing to remove one of them with the finger, or with a brush. Flakes of 
milk are removed with facility, and leave a perfectly healthy surface 
beneath ; while the patches of fungus are separated with difficulty, and 
when removed a small superficially ulcerated surface is observed, to 
which the fungus had been attached. The inflammatory patches cov- 
ered with fungous growth may continue for an indefinite period, unless 
cured by appropriate treatment. They frequently extend down the 
back of the throat, and in severe cases affect also the lining'membrane 
of the stomach. When the disease exists to any extent in the mouth 
there is usually considerable tenderness, and the infant suffers pain 
when sucking the bottle or the breast, not unfrequently declining to 
suck altogether unless very hungry. The inflamed condition of the 
mouth is almost invariably accompanied by some degree of indigestion, 
the evidence of which is found in symptoms of pain after the admin- 



196 EARLIER TROUBLES OF INFANT LIFE. 

istration of food, occasional sickness, with much sourness and dis 
agreeable odor of the vomited food, and relaxation of the bowels 
amounting frequently to diarrhoea. The motions from the bowels are 
generally green in color and mixed with gelatinous mucus, and are 
somewhat irritating to the skin around the opening of the bowel. 
This often consequently becomes reddened, inflamed, and sometimes 
slightly abraded, an appearance which has given origin to the idea 
that the thrush " passes through " the infant. This idea is erroneous, 
as the true fungus of thrush is never found on the surface of the skin, 
and is misleading in suggesting the appearance of the skin as a symptom 
of improvement in the condition of the mouth. 

In children who are properly taken care of, thrush is very seldom 
a disease of much severity ; but in neglected infants it is not un- 
frequently the cause of serious illness, and even of death, from exhaus- 
tion resulting from the secondary disorder of the digestive canal. The 
importance to be attached to it depends chiefly on the amount of 
gastric disturbance associated with its development. 

The initial cause of thrush in infants is almost invariably some 
slight disorder of digestion, resulting from improper food, or from 
food improperly administered. It is exceedingly rare in children nursed 
exclusively at the breast, while very common among infants brought 
up on any kind of artificial food ; and when it occurs its severity seems 
generally to be in proportion to the carelessness or ignorance of the 
person in charge of the infant. Uncleanliness of bottles and nipples, 
and the use of india-rubber tubing, are fertile sources of thrush in hand- 
fed children. The improper or uncleanly food seems in the first place 
to cause a slight irritation of the lining membrane of the mouth, which 
affords a favorable site for the adhesion and development of the 
fungus, which is frequently present in milk ; and the fungus, having 
once obtained a foothold, increases the original irritation, and spreads 
itself gradually over the mouth and throat. Accepting this explana- 
tion, it is obvious that the best way to prevent the occurrence of thrush 
is to conduct the artificial feeding of an infant with the greatest possible 
tare as to digestibility and to cleanliness. During the earlier weeks 
more especially of artificial feeding, at which time thrush is most 
likely to occur, symptoms of indigestion such as sickness, pain after 
ingestion of food, and unhealthy motions from the bowels, should be 
watched for, and treated when necessary by slight alterations either of 
the food itself, or of the manner of administration. The interior of 
the mouth should be examined dailj', and the first indication of the 
presence of thrush should be met by suitable treatment. This treat- 
ment should consist both of attention to the general health, and 
especially to the digestion of the infant, and of local treatment to the 
mouth and interior of the cheeks affected with the fungus, 



TREATMENT OF THRUSH. I 97 

From what has been already said of the relation of thrush to in- 
digestion, it will be understood that generally some little change in the 
form of food will be indicated. The presence of thrush practically 
proves the existence of some previous indigestion ; and this must be 
combated by some alteration in the preparation, or the form, or the 
dilution of the artificial food supplied. 

The Local Treatment to the mouth consists firstly in the main- 
tenance of the greatest possible cleanliness, and secondly in the applica- 
tion of some astringent and antiseptic remedy. If an infant's mouth 
be examined a few minutes after it has taken food, it will be remarked 
that a little of the food remains lurking in various recesses of the 
mouth, such as between the gums and the cheeks, or under the tongue. 
When thrush is present, such small remnants of food decompose 
rapidly, and not only increases the irritation of the mouth already pres- 
ent, but also afford nourishment for the fungus, and assists its growth. 
It is very essential therefore, in the treatment of thrush, to clean the 
mouth of the infant thoroughly immediately after each meal. This 
is best effected with a clean handkerchief, a small part of which is 
dipped in clean warm water, and brushed lightly but thoroughly over 
and around the interior of the child's mouth. When the mouth has 
been made quite clean, a little glycerine or borax should be applied to 
the interior with a camel's-hair brush, or with the finger. The treat- 
ment of cleaning the mouth thoroughly and applying the borax should 
be continued assiduously after each meal, until all traces of the fungus 
have disappeared, and the lining membrane of the mouth seems quite 
healthy. For the irritation which sometimes appears round the open- 
ing of the bowel great cleanliness and the application of a little vaseline 
will usually be sufficient ; in some cases thorough dusting with a pow- 
der made of equal parts of boracic acid, oxide of zinc, and powdered 
starch will be found more rapidly effective in promoting the cure. [The 
Sanitary Powder offered on page 1230 is a suitable ready-made article.] 

Diarrhoea. — Infants nourished with artificial food are considerably 
more prone to attacks of diarrhoea than those nursed at the breast ; and 
as diarrhoea is apt in such children to be not only persistent, but to 
give rise to further and more serious results when neglected, early 
attention should always be given to its cure. Diarrhoea may commence 
simply with increased frequency of action of the bowels, while the 
motions remain of normal color and consistency. In health, infants 
usually have from two to four actions of the bowels daily. When the 
frequency of the actions exceeds this number, it should be considered as 
slightly abnormal ; and when there are more than six actions in the 
twenty-four hours some steps should be taken to effect a reduction. 
More commonly diarrhoea commences with an alteration in the charac- 
ter of the motions, in combination with increased frequency. Instead 



198 EARLIER TROUBLES OF INFANT LIFE. 

of being yellow in color and uniform in consistency, the motions will 
be observed to be whitish or clay-colored; small hard masses maybe 
noticed mixed with gelatinous mucus, or with watery fluid ; or the 
motions may consist mainly of masses of curdled milk covered with 
mucus of a green color and mucilaginous consistence. Not un- 
frequently the infant will be noticed to suffer some pain immediately 
before the passing of the motions, and to have apparently a sense of 
relief for some time after. Even when diarrhoea commences with 
actions of normal appearance, if it persists, the motions always alter in 
character, assuming one of the forms mentioned above, or becoming 
almost entirely watery, with a slight sediment of yellowish or brownish 
flakes. As diarrhoea progresses, the motions may become much more 
frequent, sometimes occurring as often as once every hour. After 
persistence for two or three days, irritation of the lower bowel is often 
set up, showing itself in a tendency to strain after each motion, and 
sometimes in the presence of a little blood mixed with the mucus in 
the motion. Occasionally diarrhoea is complicated with some sickness ; 
but much vomiting is not common unless the disorder of the digestion, 
from which the diarrhoea proceeds, has progressed so far as to set up acute 
catarrhal inflammation of the stomach and bowels, a condition of 
things of so serious a character as invariably to call for skilled medical 
assistance. 

The cause of diarrhoea is almost invariably to be found in some 
disturbance of digestion, and the first step to its cure is, where possible, 
to discover what the source of its disturbance is. Frequently this will 
be found to be of a temporary and apparently trivial character. In the 
case of infants nursed at the breast, some slight indiscretion of diet on 
the part of the mother or wet-nurse, or even some mental disturbance 
or worry, may be sufficient to alter the lacteal secretion to such an 
extent as to induce indigestion and diarrhoea. When thus caused, 
diarrhoea is usually of very short duration, and passes off without call- 
ing for any remedial measures. In artificially fed infants some change 
in the quality of the milk, due perhaps to its derivation from a different 
cow, or to some change in the fodder of the cow from which the milk . 
is usually obtained, may be the disturbing cause ; or some slight de- 
composition of the milk, undetectable to ordinary sense, but sufficient 
to affect the sensitive nerves controlling an infant's digestion, may 
have taken place from atmospheric or other causes. As a general rule, it 
will be found that the digestion of infants fed artificially is more sensi- 
tive and more easily deranged than that of babies nourished on the 
secretion of the human breast ; and the disorders following derange- 
ment in such infants are apt to be more severe and pf longer duration. 
Not unfrequently an attack of severe diarrhoea is the climax of impaired 
digestion which may have existed for some little time in a modified 



THE TREATMENT OF DIARRHCEA. 199 

form. The artificial food of the infant may for some weeks have been 
partially digested with perhaps only slight discomfort and a little 
abnormal appearance of the motions, and without any apparent further 
cause diarrhoea may set in, and continue in a troublesome manner. 
In many cases an inspection of Che motions of the infant will throw 
light on the cause of the illness. If, in the beginning of the diarrhoea, 
hardened masses of curdled milk are found in the motions, it may be 
assumed that some alteration in the milk supplied to the infant or in 
its preparation is the cause of the disturbance. 

The treatment of diarrhoea in infants should be directed, in the 
first place, to the removal of any possible cause, and in the second 
place to soothing and giving rest to the irritated stomach and bowels. 
When the ingestion of some temporarily affected food is suspected, it 
is well to commence the treatment by the administration of a small 
dose of castor-oil, in order to remove any of the offending material 
which may still remain in the bowel. Usually about half a teaspoonful 
of castor-oil for an infant of a few weeks old will be sufficient to effect 
this ; if the baby is three months old, one teaspoonful will form a 
proper dose. After this has been given, the stomach should be allowed 
to rest without any milk or farinaceous food for some time. Under 
ordinary circumstances infants will never be found to suffer any injury 
from remaining without such foods for even twenty- four hours 
occasionally when the stomach is disordered, if some fluid nutriment 
be supplied at intervals in the form of thin barley-water, or of diluted 
chicken or veal tea. Not unf requently, when diarrhoea has been caused 
by some alteration in the quality of the milk, there exists for one or 
two days afterward almost complete inability to digest even pure 
diluted milk, and much the most satisfactory course to pursue is to 
withhold it altogether, until the digestive power recovers itself. After 
twenty-four or forty-eight hours, during which only barley-water or 
chicken-tea has been given, the milk or farinaceous food, more diluted 
than usual, may be given again in a tentative manner ; and with care 
the customary food may be gradually resumed. "When the disturbance 
is only slight, complete stoppage of the usual food may not be neces- 
sary ; but it will generally be found advisable to increase its dilution 
for some little time, and to lengthen as far as possible the intervals of 
administration, given in the intervals, if the baby is restless or thirsty, 
small quantities of thin barley-water. When there is evidence of 
indigestion having continued for some little time prior to the diarrhoea, 
it is proper to make an alteration in the diet of the child. Speaking 
generally, this change should be in the direction of some more easily 
digested food ; thus, for instance, if cow's milk diluted with water has 
apparently not been agreeing with the infant, dilution with barley- 
water may be tried, or resort may be had to humanized or to peptonized 



200 EARLIER TROUBLES OF IXFAXT LIFE. 

milk. It must be kept in view that when diarrhoea has once commenced, 
the digestive powers are distinctly diminished temporarily ; and accord- 
ingly not only must the food given be more diluted than would other- 
wise be necessary, but a longer interval must be allowed to elapse 
between meals, as the digestive process is slower as well as more 
feeble. It is unfortunately the case that infants suffering from diarrhoea 
have often an abnormal craving for food, and will ingest much more 
than even a healthy baby could digest ; in cases having this character 
mothers and nurses must be careful not to mistake a morbid craving for 
healthy appetite. The infant must be soothed as far as possible, and 
induced to wait during the proper intervals between meals, and when 
this cannot be managed, some innocuous fluid must be given in the 
intervals, such as small quantities of thin barley or rice water, or even 
occasionally a small teaspoonful of plain cold or tepid water. 

As a general rule, the less medicine given to infants suffering from 
diarrhoea, the more rapid their recovery will be ; and no medicine at 
all, with the exception of one small dose of castor-oil at the commence- 
ment of the illness, should be given unless sanctioned by medical 
advice. The symptoms which would indicate the urgent necessity of 
skilled advice are mainly great frequency of the motions, the presence 
of vomiting, a wasted and pinched appearance of the face of the infant, 
tendency to coldness of the hands and feet, and indications of twitching 
and convulsions. The appearence of any of those symptoms demands 
immediate attention. 

[For all infantile bowel troubles where internal irritations are prob- 
ably present, as in diarrhoea, the external use of the Magnetic Oint 
ment is appropriate, and wonderfully curative. Even in peritonitis or 
other acute inflammations where gentle rubbings could not be borne, it 
may be applied, spread thickly on soft cloths, and if renewed three 
times a day, it will be found a safe and sure reliance for both children 
and adults. For internal use the Magnetic Cramp Tablets are a fine 
remedy for children's colics, diarrhcea, indigestion, etc. See page 1228.] 

Erythema and Intertrigo. — The redness and irritation around 
the opening of the bowel which frequently results from diarrhoea has 
already been described, and its proper treatment indicated. A similar 
affection of the skin of the thighs, the groins, and the front of the 
abdomen not unfrequently arises in infants from some irritating 
quality in the urinary secretion. As a result of some form of indiges- 
tion in babies, the urine is apt to become high-colored and of offensive 
odor. Urine of this description seems to be very irritating to the 
delicate skin of the infant ; and unless the diapers are changed frequent- 
ly, and great care in cleanliness is taken, the skin with which the we? 
diapers come in contact becomes inflamed, reddened, and sore-lookiu^. 
developing a condition which is technically known as erythema, or. 



SAND OR GRAVEL 2ol 

when occurring chiefly in the folds of the groins, as intertrigo. The 
irritation often exists to such an extent as to cause exfoliation of the 
superficial layer of the skin, and abrasions result here and there, 
approaching a condition of slight ulceration. Sometimes in place oi 
the general redness, an eruption of small papules or pimples occurs, 
with normally colored skin intervening between the papules, the heads 
of which are often slightly flattened and abraded. There is usually no 
difficulty in determining the nature of this irritation, and distinguish- 
ing it from other erythematous or papular eruptions. Its limitation to 
the part of the skin covered by the diapers, and its association with 
disagreeably smelling urine, are usually quite sufficient to indicate its 
character. To effect a cure quickly, attention must be given to the 
diet of the child, while at the same time soothing applications are 
made to the inflamed surface. It will often be found when intertrigo 
occurs that the diet of the infant has been somewhat too rich or too 
abundant, and it will be necessary to increase the dilution of the food, 
or to limit the quantity. In other cases, the condition of the urine, 
together with the appearance of the motions, will lead to the conclusion 
that the food is being imperfectly digested, and an entire change of 
diet may be called for. The local treatment should consist mainly of 
very frequent changing of diapers, great cleanliness, and the applica- 
tion Df some soothing powder or ointment. As far as possible, the 
diaper should be changed immediately the baby has passed water, how- 
ever frequently this may occur ; and at least twice or thrice daily the 
skin affected should be bathed thoroughly, dried carefully, and pow- 
dered well with plain starch-powder, or with a mixture of powdered 
starch and oxide of zinc. When this is insufficient to effect a cure in a 
few days, it may be necessary to apply some ointment in place of the 
powder, after the bathing and drying. The best ointment for this is 
one made of equal parts of zinc ointment and Carron-oil : this is very 
soft and cool, and forms a most soothing application for the irritated 
skin. Nurses are rather prone to blame the inefficient washing of 
diapers as the cause of intertrigo in infants, but it is very doubtful i f 
this is ever the real cause of the irritation. There is no doubt, how- 
ever, that it is often induced by laxity in changing the diapers with 
sufficient frequency. 

Sand or Gravel. — In close relation to the condition of urine result- 
ing in intertrigo is that which is characterized by the deposition of what 
is popularly known as "sand" or gravel, and scientifically as uric 
acid. When this affection of the urine exists in infants, the sand is 
observed as a brick-red or yellowish-red deposit remaining upon the 
surface of the diaper, after the urine has been absorbed. If the diaper 
is dried carefully, the deposit will be noticed as a sandy powder which can 
be grated between the fingers. Its occurrence is not uncommon in young 



2Q2 EARLIER TROUBLES OF INFANT LIFE. 

infants, and unless persistent, or of very frequent recurrence, is of nc 
serious import. When it is observed for some days continuously, an 
indication is given of some disorder of digestion, due generally to a 
somewhat too rich diet, and some little alteration must be made to 
obviate this. "When infants are taking farinaceous food, the presence 
of sand may indicate an insufficiency of fluid diet and consequent con- 
centration of the urine, an error easily rectified by increasing the 
dilution of the food with milk or water. The presence of uric acid or 
gravel in the urine of infants is apt to give rise to some pain in passing 
water ; and the child will be observed to refrain as long as it possibly 
can from doing so, and to cry during the act or immediately afterward. 

Crying during micturition should always excite suspicion of 
some irritating character of the urine, and inspection of the diapers 
will generally afford a satisfactory explanation of the discomfort in- 
volved in the act. If no abnormal appearance of the urine is detected, 
the discomfort in micturition is usually due to some slight irritation or 
malformation of the external urinary organs of the infant, and an ex- 
amination should be made in order to detect any abnormality. In male 
infants this will sometimes be found in abnormal length or narrowness 
of the foreskin, a condition which will call for medical aid, and usually 
for the slight operation of circumcision. In female infants abnormal 
conditions are not so common, but occasionally the urinary passage is 
partially blocked by a small membrane stretching across the opening, 
which requires to be removed by a slight incision. 

Constipation, or confinement of the bowels, is a not unfrequent 
trouble presenting itself in infants, more especially perhaps in those 
not very robust at their birth. It has already been stated that usually 
an infant passes three or four motions in the twenty-four hours. A 
smaller number would not be considered abnormal if the motions were 
of fair size and of proper consistency ; but if only one or two motions 
are passed in the twenty-four hours, and these small and somewhat 
hard, the condition would be described as one of slight constipation ; 
while, if the child has no action of the bowels for one or two days at a 
time, a degree of confinement exists which calls for careful attention 
"When constipation is present to this extent, the motions will usually 
be found to be very hard, and to cause considerable discomfort, if rot 
pain, to the baby in passing them ; sometimes, indeed, the baby strains 
so hard, and has so much difficulty in passing the motion, that a little 
blood exudes from the edge of the opening of the bowel. 

For the immediate relief of constipation existing to the extent 
described above, it is usually desirable to administer an injection of 
either water, oil, or glycerine. If the child exhibits a tendency to pass 
the motion by occasional straining, it is best to assist by an injection 
of one or two ounces of olive-oil, administered by means of a pear- 



REMEDIES FOR CONSTIPATION. 203 

shaped india-rubber injection syringe of a size just sufficient to hold 
the quantity indicated, and fitted with an ivory or vulcanite nozzle. 
When there is no tendency to natural action of the bowel, this should 
be stimulated by the injection of a teaspoonful of pure glycerine, 
introduced by the syringe described for the purpose in Chapter IV. If 
the glycerine injection does not produce a proper action of the bowel 
in a quarter of an hour, a full injection of warm water should be given 
with an ordinary family syringe, the injection being administered 
slowly, and as much water being used as it is possible to inject. If 
more is injected than the infant can accommodate, it will always re- 
turn at once by the side of the nozzle, so that no fear need be enter- 
tained of causing injury by injecting too large a quantity. Fuller 
directions for administering an enema of this kind are given in Chapter 
IV., p. 33 and are equally applicable to infants as to adults. 

General Rules for Prevention of Constipation.— After im- 
mediate relief has been afforded, steps must be taken to prevent the 
recurrence of the constipation, and to remove the tendency to it. To 
effect this, it is usually necessary to make some alteration in the 
infant's diet. Some foods are more constipating than others, and a 
change should be made from those to some of a more laxative charac- 
ter. Generally speaking, malted foods assist in maintaining the regular 
action of the bowels, while, on the other hand, peptonized milk some- 
times produces a tendency to constipation. If the food previously 
given to the infant has been digested satisfactorily, with the exception 
of the confinement of the bowels, it is not usually desirable to give up 
its use altogether ; the better course is simply to substitute once or 
twice daily another food which may assist in promoting the action of 
the bowels. In some cases where infants are fed on diluted cow's 
milk, the addition of a little cream aids in preventing constipation ; in 
similar cases also the administration of a quarter of a teaspoonful of 
cod-liver oil once or twice daily is effective and advantageous. 

One farinaceous food, Scotch oatmeal, is often exceedingly effec- 
tive in the treatment of constipation, and cannot unfrequently be 
digested by very young infants if properly prepared. It is, however, a 
somewhat rich food, and in some children produces considerable irrita- 
tion of the skin. Its employment in cases of persistent constipation 
should always be tried, the amount given being limited when any signs 
of irritation in the form of " heat-spots " or slight eczema are exhibited. 
Oatmeal is prepared in various degrees of coarseness, and sometimes 
one form can be digested satisfactorily when another is unacceptable. 

So far as possible, the use of laxative medicines should be avoided 
-with infants. "When the constipation persists in spite of various 
changes of diet, it is best to excite the action of the bowels, when 
necessary, by injections of olive-oil or glycerine, waiting for the time 



204 EARLIER TROUBLES OF INFANT LIFE. 

when the increasing age of the baby will admit of greater variety of 
diet. 

[Having previously found occasion to mention the Magnetic Oint- 
ment as a fine remedy for diarrhoea and intestinal irritations, it may 
at first sight seem curious to the reader to find it here also recommended 
for relief of constipation ; but it is no mistake, nor unfounded claim, to 
say that it "works well both ways." In using it for constipation con- 
siderable rubbings or deep manipulations of the bowels are necessary, 
and possibly these are what "move the bowels," but the ointment 
certainly goes well with the massage to prevent soreness therefrom as 
indeed it is an aid to massage anywhere.] 

Inflammation of the Eyelids is a trouble not unfrequent in 
young infants, which calls for much care in order to prevent serious 
ulterior results. Its presence is usually indicated first by the collection 
of a little watery matter at the inner corner of the eye, which tends 
to run down the cheek. This is accompanied, or immediately followed, 
by some swelling of the eyelids, which are kept persistently shut, and 
are reddened and discolored as well as swollen. If the eyelids are 
separated with the fingers, the eyes are seen to be injected, and more or 
less covered with the watery matter, which runs out on the separation 
of the lids. When the inflammation is slight, and attended to at its 
commencement, it usually subsides entirely in a few days. The great 
point in the treatment is excessive cleanliness. The eyes must be 
bathed carefully three or four times a day, or oftener if necessary, 
with clean warm water, or warm milk and water, and care must be 
taken not to expose them to a bright light. In bathing the eyes, it is 
not sufficient to bathe merely the outside of the lids, but the water, or 
milk and water, must be introduced within the lids, so as to wash 
thoroughly the surface of the eye. It is not difficult to do this if it is 
done in a proper manner. 

Application of Lotion to Infant's Eyes.— The best method of 
doing it is here described, two persons being required — one to hold the 
baby, and the other to apply the lotion properly. The one holds the 
baby on the knee, with its face toward her, while the other sits down 
immediately opposite, and in close proximity to the first, having at her 
right-hand side a bowl or cup containing the lotion, and some small 
pledgets of clean absorbent cotton wool, and, spread over her knees, a 
soft thick towel. This latter person separates a little her knees, with 
the towel lying upon them, while the one holding the baby lowers its 
head backward until it rests on the towel, in the hollow between the 
knees of the person sitting opposite. The head of the infant is grasped 
gently but firmly between her knees, and while the holder of the baby 
confines its hands and holds its body firmly, the other, holding the 
head between her knees, has both her hands tree to apply the lotion. 



CLOSED TEAR DUCTS. 



205 



With her left hand she separates the lids very gently, by pressing on 
the bony projections above and below the eye, while with the right she 
carefully bathes the eye with pledgets of wool soaked in the lotion. 
The process is very simple if done by two persons acting together in 
this way, and the only precaution necessary is that all pressure on the 
eyes themselves should be avoided in opening the eyelids. If the fore- 
finger and middle-finger of the left hand be used for separating the 
lids, and care taken that they rest on the bony prominences well above 
and below the eye, no risk whatever to the eye will ensue, and the lids 
will be separated to a sufficient extent without milch difficulty. Before 
attempting the separation, it is always well to dry the skin in the 
neighborhood of the lids thoroughly with the towel on the knees, 
otherwise the fingers are very apt to slip. The cotton-wool pledgets 
should be destroyed after use, as the discharge from the inflamed eyes 
is contagious ; and the towel employed should not be used for any other 
purpose. When a child is suffering from inflamed eyes, cloths and 
flannels used for washing it should never be employed for other chil- 
dren, and a special towel should be kept for its sole use, on account of 
the risk of contagion from the discharge. When the discharge exists 
to such an extent as to require washing more than three or four times 
a day in order to keep the eyes clean, medical aid should be had re- 
course to. Special lotions are then necessary, and neglect of early 
treatment may be followed by injuries to the surface of the eye which 
will permanently damage the sight. 

Congenital Closure of Lachrymal Ducts. — A condition of things 
which may be mistaken for inflammation of the eyelids sometimes 
results from congenital closure of the small canals at the inner corners 
of the eyes which normally fulfil the purpose of carrying away to the 
nose the secretions from the surface of the eyes. When these are not 
pervious, the secretions collect like a tear in the corner of the eye, and 
run down the cheek, not finding their proper outlet into the nose. This 
condition of matter does not, however, lead to the swelling and dis- 
coloration of the eyelids characteristic of inflammation, but is of course 
much more persistent, as it continues until by surgical means the pas- 
sage is made clear. The earlier that this is done the better for the 
child ; mothers should therefore lose no time in drawing the attention 
of their medical attendant to any persistent accumulation of fluid in the 
corner of an infant's eye or to any continued tendency of tears to flow 
down the cheeks. 

Vaccination. — [This is the only subject of importance on which 
the editor of the American Edition of this work differs so much from 
the author as to take exactly the opposite position, and the reader will 
please bear in mind that it is Dr. Foote, Jr., and not Dr. Westland, 
who pens what is presented on this subject. 



2 o6 EARLIER TROUBLES OF INFANT LIFE. 

Dr. Westland includes vaccination among the " minor troubles of 
infancy/' and names it as the one which is imposed by English law, the 
compulsory feature of which he seems to approve, for he says "it is 
the duty of every law-abiding person to submit to it," as it was es- 
tablished only after the fullest inquiry into the efficacy of vaccination ; 
but, though his revised edition is dated 1898, the year in which the 
compulsory sting of the law was taken out of it, he says nothing of 
this new provision by which any parent who has good reason for dis- 
crediting vaccination and who prefers to save his infant from its risks, 
may do so by proclaiming his views before the proper official and 
obtaining a certificate of exemption. This modification of the English 
law followed a long investigation and report by a " Royal Commission " 
for the investigation of vaccination and its disasters, by which it was 
shown that not only "discomforts" but serious illness and deaths were 
possible results of all the methods of vaccination practised. The report 
and the last law favored " glycerinated calf lymph" as safe and free 
from the harmful organisms which are said to constitute the dangerous 
elements of other forms of vaccine virus. It is worthy of remark here 
that for many years there has been a battle of the "lymphs," and 
special claims were put forward for the purity and surety and safety of 
various modes and makes of vaccine virus. The opponents of vaccina- 
tion always declared that they were all bad in the sense of being risky, 
and the vaccinators were driven from one to another, until they planted 
their flag over this last ditch of glycerine lymph, from which position 
they are hurling as much abuse at "ivory points" as the anti-vaccina- 
tors ever did.' Now their last hope is failing them, for The Lancet, an 
English medical magazine of authority among the profession, recently 
appointed experts to examine all the glycerine vaccine lymphs offered 
at present, and they were all found " to swarm with extraneous organ- 
isms," so that The Lancet admits that "an absolute degree of purity 
maybe unattainable," and the old war-cry of the opponents is justi- 
fied — "there never was a pure virus and cannot be." To judge by the 
claims of the various makers of vaccine virus they have already gone 
the length of possibilities in adopting all practicable means of prevent- 
ing contamination by what are called sterilizing processes, and more 
they cannot do ! Dr. Richard Slee, of Swiftwater, Pa. ( in a paper 
read before the Associated Health Authorities of Pennsylvania, February 
24, 1899), admits that " the production of vaccine virus is not an exact 
science — there are many unsolved problems." He admits the impossi- 
bility of producing a vaccine free from contamination, but (before The 
Lancet's investigation) believed that the harmful germs die out in 
glycerine, and that the "unpleasant accompaniments or results of 
vaccination " come from after-poisoning of the wound made by vaccina- 
ting. At one time all vaccinators were endeavoring to make light of 



KEEP CHILDREN FREE FROM ALL DISEASES. 207 

or even deny the unexpected and undesired complications, but now it 
is only the glycerine lymph that they try to protect from reproach, and 
at last, when these become too frequent and evident to deny, they 
will fall back on the argument of Dr. Joseph Korosi, of Budapest, 
quoted in Dr. T. M. Rotch's "Pediatrics" (a recent standard medical 
work). Dr. Korosi is quoted as a most reliable statistician, and it seems 
he has made a study of 112,000 reported cases of deleterious effects of 
vaccination and concludes that even if an increase of deaths can be 
charged to vaccination, there should be placed to its credit a saving of 
three hundred times as many lives as it costs ; but "this is another 
story " — the question of the utility of vaccination— and it is too long to 
enter upon here. Suffice it to say that more and more members of the 
profession are getting their eyes open on this subject, and coming to 
accept the conclusion of Professor E. M. Crookshank, M.B., of King's 
College, London, who made a thorough study of it for himself and 
then said : 

" Inoculation of cow-pox does not have the least effect in affording 
immunity from the analogous disease in man, syphilis ; and neither do 
cow-pox, horse-pox, sheep-pox, cattle-plague, or any other radically 
dissimilar disease, exercise any specific protective power against human 
small -pox." (Vol. I., page 464.) 

All this playing with poxes or "disease mongering" will be some 
day entirely done away with, and looked back upon with shame by the 
successors of those who have practised it, claimed use for it, and made 
abundant excuses for the hundreds of thousands of disasters thus 
needlessly thrust upon helpless, long-suffering infants. 

Keep Children Free frcm all Diseases. — In the "Bulletin of the 
State Board of Health of Tennessee " was once published an article 
making a strong protest against the prevalent and false idea "that it is 
better for children, while young, to have such diseases as mumps, 
measles, scarlet fever, and be over with them." Among the more 
ignorant classes there exists the practice of deliberately exposing their 
little ones to all such diseases as they come around, but the Bulletin 
truly says that they are all liable to be followed by serious conse- 
quences, even death, and therefore, "under the teachings of modern 
preventive medicine to do such an act is but to perpetrate upon the help- 
less child the grossest lorong. The only just and intelligent rule under 
any and all circumstances is 'keep children from all children's 
diseases.' These are the words of one of our most distinguished writers 
upon children's diseases, and they constitute the working rule of every 
health officer in the land." "Would this were true instead of false! 
Vaccinia is a child's disease, and officials diligently spread it, repeatedly 
and compulsorily, in spite of severe complications and some uncertain 
proportion of deaths. Will they never get their eyes open to the gross 



20 8 EARLIER TROUBLES OF INFANT LIFE. 

Inconsistency between their preaching and practising ? How can they 
dispel a "popular fallacy" while pushing their own medical fallacy ? 
The only consistent sanitarians are the anti-vaccinators. They have 
a never-failing preference to keep clean and healthy ; they worship at 
the shrine of Hygeia and decline to bow down to the beast of vaccina- 
tion. There are level-headed doctors among them, of all schools, and 
men of all professions who think in line with modern sense and true 
sanitation. There are hundreds of "common people" who have been 
hurt by vaccination, and have sense enough to know it, and are not be- 
fuddled by the obfuscating doctors who would make them believe that 
its nice to be sick, that clean health is to be had by promoting filth 
disease. They are, however, yet willing to let those that icant it hate 
it, and all they want of it, but the more its advocates urge its protective 
powers, the more the protestants protest that there is no need to enforce 
it on them and theirs — they merely say "excuse us." 

We wish to say to the many well-meaning doctors who take part 
in the tacit conspiracy to " preserve vaccination from reproach," stop 
and think and, for a moment, admit that vaccination can serve no 
useful purpose, that its supposed "beautiful beneficence" is all a 
delusion, that you have been misled by the power of precedent and 
authority, and that creditable, cleanly, welcome sanitary precautions 
are after all the true and only effective prophylactic against small-pox ; 
then consider the days and nights of pain and suffering, even the 
thousands of years in the aggregate, that vaccination has inflicted on 
the human race, the numerous cases of life-long chronic ailments that 
have been traced to its influence, and the unknown number of fatalities 
(about one a week acknowledged and recorded in England for ten 
years); figure up the account against vaccination, and if, as we are 
fully convinced, there is nothing to be gained by it, what can the medi- 
cal profession do for mankind to atone for one hundred years of foster- 
ing this greatest of all medical delusions, what can it say in extenua- 
tion of the evil done through this, its most fearful error, and what 
excuse can it now offer for "going it blind," refusing to study 
and investigate, and absolutely persisting in coercing the people to 
continue a practice positively proven to be attended with great risks 
and frequent fatalities ? If you are in error the score against you is a 
fearful one, but delaying confession can only make it worse. 

This book was written to mitigate the troubles of infant life, and 
the writer of this interpolation does not consider it the function of a 
physician to add to them in any way. The indictment against vaccina- 
tion is not based merely on the unusual ulcers and prolonged sore arms, 
and wasting fevers of erysipelas and pyaemia (blood-poisoning) which 
may result from it, or even the cases that soon end fatally ; the latter 
might be envied by the miserable children blighted for life, crippled, 



HEALTH THE BEST RELIANCE. 209 

distorted, and damaged beyond repair by the ravages of disease directly 
due to vaccination (possibly, no doubt, in some cases because imposed 
on a weakly constitution). Besides these aggravated instances of 
visible ruin of which there are living specimens as well as photographs 
to exhibit, we must not forget the thousands of cases of moderate 
chronic ill-health from long lingering impairment of the blood and 
disorder of vital processes dating back to vaccination. 

It is the physician's function to prevent and relieve disease, not to 
inflict it, nor even to impose a slight one in expectation of warding off 
another that would probably never come ; and so far as the writer of 
this is concerned in the production of a book for the people, instruct- 
ing them in the care of their young, he feels it his duty to urge them 
by all possible means to work for the maintenance of health and the 
avoidance of all disease, believing with Virchow, the greatest German 
pathologist, in his latest expression of opinion on this subject, that 
health is the most sure protection against "disease germs'' or the 
pernicious microbes that are found to be attendant in a great variety 
of diseased conditions. Do all you can to keep 3 r our child's blood clean 
and pure, and nothing to contaminate or deprave it. This is the true 
religion of hygiene; vaccination is "playing the devil," and often 
"there is the devil to pay." 

Dr. Westland devotes two or three pages to describing the "nor- 
mal progress of vaccination, " and what to do for the minor complica- 
tions, but this space has been devoted (as I think) to better use, and it 
only remains to say that if a parent yields his child to vaccination, he 
should hold the operator responsible for results. Do just as the physi- 
cian advises, as to care of the wound, and all after-treatment, so that 
it may not be possible for him to lay the blame upon you if any sort of 
complication results ; and require him to keep the child under observa- 
tion so that he cannot escape responsibility by saying "you didn't call 
my attention to this in time." It is a far too common practice for 
physicians to vaccinate from a dozen to one hundred or more infants a 
day and then leave the results to fate and the lack of care of parents 
who have enough other troubles on their hands. — E. B. Foote, Jr.] 



CHAPTER XVIII. 



Some Disorders Associated with the Process ot Dentition. 

Condition of Nervous System during Dentition; Difference of Manifestations 
in First and Second Dentitions; Affections of Gums and Mouth; Ulcers of 
Mouth; Distinction from Thrush; Feverish Attacks ; Kestlessness at Night; 
Disorders of Digestion ; Treatment; Colic and Diarrhoea ; Cold and Cough; 
False Croup; Bronchial Catarrh; Necessity of Care; Treatment of Cold, 
of False Croup, of Bronchitis; Child-crowing, Treatment; General Con- 
vulsions, Treatment; Abscess of Ear; Treatment; Night Terrors; Other 
Mental Peculiarities. 

Condition of Nervous System during Dentition. — During the 
two periods of dentition, both when the child is cutting the first set of 
teeth, between the ages usually of six months and two years, and when 
developing the second set between six and thirteen years of age, 
various disturbances of health are apt to present themselves. While 
dentition is proceeding the nervous system of children appears to be- 
come very irritable ; and as a result, slight causes of disturbance, which 
in general would scarcely produce any visible effect, are apt to be 
followed during teething by consequences apparently out of all propor- 
tion to their influence. In this condition a very slight chill may be the 
exciting cause of severe bronchitis, while the ingestion of some not 
very easily digested food may result in violent diarrhoea or even acute 
inflammation of the bowels. A special feature of this period of life is 
the facility with which considerable fever with much increased tempera- 
ture is induced, a condition in itself tending to increase still further the 
already excitable state of the nervous system. While it cannot be said 
that any of the illnesses to be described in this chapter are exclusively 
associated with the eruption of the teeth, they yet occur so frequently 
during these periods, and when they occur manifest so apparently 
some relation to the dental development, that it is most convenient to 
describe them here. Some of them are evidently the direct result of 
the passage of the teeth through the gums ; others, more especially the 
disorders affecting the nervous system, belong to a class known in 
medicine as "reflex nervous phenomena," an expression which means 
here that the irritation of the nerves of the gums, produced by the 

pressure of the advancing teeth, is prone to relieve itself by some mani- 

210 



IRRITATION OF THE GUMS. 211 

festation of irregular nervous discharge in some other part of the body, 
giving rise, it may be, to muscular spasms or convulsions. The dis- 
turbances of health due to teething occur with much more frequency 
and greater severity during the first than during the second dentition, 
and the specific descriptions which follow apply only to the earlier 
process, which takes place usually between the ages of six months and 
two years, unless where it is specially stated that the second dentition 
is referred to. It is to be understood that the second dentition is 
occasionally characterized by similar affections, which however at that 
period rarely present themselves in the acute form in which they 
appear during the eruption of the first or milk teeth. In the first place 
will be described the affections of the gums and mouth which result 
directly from the eruption of the teeth through the tissues which cover 
and conceal them for some months after birth. 

Affections of Gums and Mouth. — Generally, for some weeks or 
even for two or three months before any teeth make their way through 
the gums, their appearance is foreshadowed by slight irritation of the 
gums, accompanied by an excessive secretion of saliva, which flows 
occasionally from the mouth of the child, an occurrence generally 
known as "dribbling." This is usually associated with some slight 
irritability of temper, shown by a tendency to cry on slight provoca- 
tion ; and is apparently relieved by rubbing and pressure, as the infant 
will be observed to bite its own fingers or any other substance conven- 
ient, and to derive comfort from doing so. It will usually be noticed 
also that the child when fretful can be soothed by its mother or nurse 
gently rubbing its gums with her finger. If the gums are examined 
during this period, they will be found to be somewhat swollen and of 
a rather brighter red color than normal. Immediately before a tooth 
comes through, the gum covering it will often be seen to be very tense 
and swollen, and at this stage may sometimes be so tender that the 
child resents any attempt to touch it. This swelling and tenderness 
subside directly the tooth has made its way through the gum, and a 
period of comparative comfort ensues until another tooth arrives at the 
same stage. The amount of discomfort suffered varies very much with 
different infants. Some cut all their teeth with practically no discom- 
fort, while others suffer pain and become irritable during the eruption 
of every individual tooth. In this respect it seems to matter little 
whether the teeth are cut comparatively early or late. As a rule, the 
double teeth and the canines give rise to more discomfort than the 
incisors, but this is a rule not by any means without many exceptions. 
In addition to the irritation of the gums so frequently present, some 
inflammation of the rest of the mouth is not very uncommon ; and this 
sometimes exists to such an extent as to irive rise to small ulcers, which 
are occasionally seen not only on the tongue, but also on the inside of 



212 DISORDERS WITH PROCESS OF DENTITION. 

the lips and cheeks. They are readily distinguished from the little 
ulcers which occur during thrush, by the absence of any appearance of 
the white fungus growth characteristic of that disease ; moreover, 
thrush is very seldom observed in children in fair health after the age 
of six months. The inflammation and irritation of the gums and 
mouth very seldom exist to such an extent as to interfere materially 
with the infant taking food ; not unfrequently indeed an increased 
desire for food is observed, the contact with the nipple of the bottle or 
with the feeding-spoon apparently giving a sense of relief, while the 
food has a soothing effect upon the inflamed surface. 

The irritation of the gums resulting from teething is generally 
associated with irregular feverish attacks, characterized by abnormally 
high and capriciously varying temperatures. If the temperature of the 
child be taken occasionally with the clinical thermometer, a temporary 
rise of temperature of three or four or even more degrees will not un- 
frequently be noticed ; and if careful observations are made the altera- 
tions in temperature will be found frequent and erratic. 

Resulting from this in some measure is the restlessness at night 
which is often remarked. The child wakens suddenly in its sleep and 
cries out, or is restless and disturbed, kicking with its legs and moving 
its arms frequently. As a secondary result of the feverishness, dis- 
orders of digestion are prone to occur, assuming generally the form 
of diarrhcea with colicky pains giving rise to occasional attacks of loud 
crying, sometimes of vomiting and intolerance of the food which pre- 
viously had been satisfactorily assimilated. 

Treatment of Affections of the Mouth. — These various troubles 
are susceptible of much alleviation by the employment of remedies, some 
local and some general. For the dribbling alone no treatment is neces- 
sary, but when the irritable condition of the gums is troublesome, it is 
well to rub them once or twice daily with some slight astringent such 
as glycerine of borax. This should be applied gently with the finger 
of the mother or nurse. Gentle friction with fresh lemon-juice is also 
frequently of much value in soothing the discomfort. At the same 
time the occasional use of some mild laxative medicine is advisable, 
half a teaspoonful of castor-oil. or a teaspoonful of sweet essence of 
senna, being an eligible dose for a child of one year. When similar dis- 
comforts arise during the second dentition mild saline purgatives, such 
as effervescing citrate of magnesia, are of much value, and are best 
administered in the morning before breakfast. When a tooth is ob- 
served actually projecting under the swollen and tender gum, lancing 
with a sharp and clean lancet will generally afford immediate relief, 
and complete the eruption through the gum. For the treatment of the 
small ulcers on the mouth described above, nothing is better than the 
application two or three times daily of glycerine of borax ; their cure 



COLIC, DIARRHOEA, COLDS AND COUGHS. 213 

is hastened also by the administration internally of a little chlorate of 
potash, one grain of which to each year of the child's age may be given 
three times daily. The feverish attacks are generally relieved most 
quickly by the administration of laxatives, among the most eligible of 
which are sweet essence of senna or compound licorice powder. 
Combined with this laxative treatment, the employment of tepid baths 
night and morning is often very beneficial. The water in the bath 
should have a temperature of about 90° F., and the child should re- 
main in it five or ten minutes. A bath at this temperature, given just 
before bed-time, is often of much value in inducing and maintaining 
quiet sleep. 

Treatment of Colic and Diarrhoea. — When there is any tendency 
to these disorders, great care in diet must be taken, and the stomach 
and abdomen of the child must be clothed very warmly. The only 
laxative medicine permissible under such circumstances is castor-oil, and 
this should only be given early in the attack. When the diarrhoea 
persists, it may be necessary sometimes to stop for a day or two the 
administration of farinaceous foods, and to feed the child exclusively 
on animal broths, such as chicken-tea, veal-tea, or beef-tea, together 
with some milk diluted with barley or lime water. In older children 
during the second dentition diarrhoea is rarely troublesome, and is 
usually cured quickly by one or two teaspoonfuls of castor-oil taken at 
the commencement of the illness, and followed by abstinence for a day 
or two from all foods likely to irritate. It is desirable to emphasize the 
importance of temporary abstinence from food in ,all cases of acute 
irritation of the digestive canal ; children in ordinary health never 
suffer from even complete starvation for twenty-four hours, if any 
thirst is allayed by water or other innocuous fluid. 

Cold and Cough. — The disturbance resulting from dentition fre- 
quently manifests itself in slight inflammation of the lining membrane 
of the nose, the windpipe, and the bronchial tubes, giving rise to cold 
in the head, and to attacks of cough varying in character according to 
the part of the windpipe and bronchial tubes affected. In most cases 
where actual false croup or bronchitis occurs during teething, it is 
probable that some temporary exposure to cold has combined with the 
irritation of teething to cause the illness ; but the susceptibility to this 
form of disease is so strong in many children at this period of their 
lives, that the most careful attention to warmth is not invariably 
successful in preventing the attacks, although doubtless of much value 
in mitigating their severity. 

The colds, as they are popularly termed, usually commence with 
difficulty in breathing through the nose, accompanied by some watery 
or mucous discharge, and a tendency of the eyes to water. There is 
generally also slight fever, and restlessness at night, often, at least in 



2i 4 DISORDERS- WITH PROCESS OF DENTITION. 

young children, due more to the difficulty in breathing through the 
nose, than to the discomfort resulting from the fever. Within a day 
or two a hoarse croupy cough develops, associated with some hoarse- 
ness of the voice, and occasionally actual discomfort in speaking. 

False Croup. — It is at this stage that the apparently alarming 
but not really very serious attacks of so-called false croup are apt to 
occur during the night. Children vary very much in their suscepti- 
bility to such attacks, some never suffering from them however fre- 
quently they may take cold, while others seldom pass through a cold 
without experiencing one or more attacks. The child has perhaps been 
fairly well all day, with only a slight cold in its head, and possibly a 
little hoarseness of the voice with slight cough. Within one or two 
hours after falling asleep it wakens apparently choking, with loud 
ringing cough, and great difficulty in drawing in its breath. It usually 
starts up in bed, grasps the side of the bed and anything else within 
reach, and struggles for breath for perhaps a few minutes, coughing 
in a characteristic manner very frequently, and drawing in its breath 
often with a sound like the "whoop" of whooping-cough. This con- 
dition seldom lasts in an acute form for more than a few minutes ; but 
for some little time afterward slight difficulty in inspiration is often 
present, and young children are usually much frightened and cry for 
some time after the attack. In the course of perhaps twenty minutes 
or half an hour all traces of the attack may have disappeared, and the 
child will again sleep peacefully as before. 

Bronchial Catarrh. — A day or two later in the course of the cold 
the cough generally alters in character, becoming the cough of ordinary 
bronchitis, and the hoarseness disappears ; slight wheezing sounds may 
be heard if the ear is applied to the chest of the child, and perhaps 
some little increased quickness of breathing, due to the bronchial tubes 
being partially obstructed by mucus. Children of five years old and 
upward will usually cough up and expectorate some of this mucus, 
which is generally of a whitish gelatinous character, tending to become 
more yellow and less thick as the illness progresses ; younger children 
almost invariably swallow it after bringing it up into the throat, and, 
as a result of its entry into the stomach, some temporary indigestion is 
usually set up in addition to the bronchial irritation. If good care be 
taken of the child at this period, the cough usually becomes softer and 
less frequent, and recovery quickly ensues. What has been described 
here is the course of an ordinary cold affecting a child during dentition. 
In children prone to bronchitis, or subjected to severe exposure to 
cold, the inflammation attacking the windpipe and that affecting the 
bronchial tubes may be very much more acute ; but these severe at- 
tacks of laryngitis and bronchitis, as they are severally termed, fall 
to be referred to rather under the heading of the Common Maladiei 



TREATMENT OF COLDS. 215 

of Children, than in a chapter devoted to the disorders connected with 
dentition. 

Necessity of Care during Dentition. — From the description 
given above, it should be obvious that even slight colds, affecting the 
head only, should never be neglected in children at the period of teeth- 
ing. The earlier care is taken, the more probable it is that the cold 
will be cut short and prevented from running through its various 
stages ; and even if this is not effected, early care will go far to 
diminish and render unimportant the later developments. 

Treatment of Cold. — If the weather be at all cold, the child 
should be confined to one room properly heated and ventilated, and 
care should be taken to maintain the temperature of the room through- 
out the night. There is no doubt that many of the attacks of false 
croup are brought on by lowering of the temperature of the room in 
which the child sleeps at night. Ordinarily a child breathes entirely 
through its nose, and the air is warmed and rendered moist before it 
reaches the windpipe by contact with the internal surface of the nose. 
When the nose is closed by cold, the child is compelled to breathe 
through the mouth, and the cold air enters directly, with very little 
previous heating, into the windpipe, the very sensitive surface of which 
is irritated and dried. Some spasm of the vocal cords at the entrance 
of the windpipe is excited by this irritation, and this spasm, along with 
the cough resulting from the same causes, constitutes essentially the 
attack described above as false croup. 

In addition to keeping the room warm at night, it is of importance 
to maintain the warmth of the hands and feet of the child. It should 
be clothed in a flannel night-dress, and a bottle filled with warm water 
and covered with flannel should be placed near its feet. A warm bath 
given just before placing the child in bed, the water being of the tem- 
perature of 100° F., is often of much value in promoting perspiration 
and thus relieving the fulness of the head ; and this is assisted also by 
the administration of some warm drink, such as gruel or an infusion of 
jam in hot water, before the child goes to asleep. When any hoarse- 
ness or cough appears, some stimulating liniment [no liniment is equal 
for this purpose to the Magnetic Ointment] should be rubbed well 
into the chest and back night and morning ; or, especially if the child 
is feverish and restless, a weak mustard-poultice, made of one-fifth or 
one-fourth part of mustard to four fifths or three-fourths of linseed, 
should be applied to the chest for one or two hours, and on its removal 
should be replaced by cotton-wool. Mustard-poultices well made are very 
soothing, even when they irritate the skin slightly, and often promote 
sleep. When a child falls asleep with one on its chest, care must be 
taken to remove it at the proper time, otherwise more irritation of the 
skin than was intended may result. 



216 DISORDERS WITH PROCESS OF DENTITION. 

• When the- cough is frequent and troublesome, much relief is often 
given by the administration of a few drops of ipecacuanha wine iu a 
teaspoouful of glycerine every two hours. Children are very tolerant 
of this drug, and will take it in almost as large doses as adults. To a 
child of one year old, five drops may safely be given every two hours, 
while a child of five will take ten drops without experiencing any 
nausea or other discomfort. 

Treatment of False Croup. — For the spasmodic attacks which 
occasionally occur at night, the best treatment is immersion in a warm 
bath of 98° F., accompanied by an emetic in the form of one or two 
teaspoonfuls of ipecacuanha wine. The ipecacuanha should be given 
as soon as the child can be induced to swallow it ; and if vomiting does 
not result in a few minutes, it should be induced by introducing the 
finger into the mouth and tickling the back of the throat. If enough 
warm water for a bath is not readily available, the application of a 
sponge wrung out of warm water to the outside of the throat, just 
under the chin, is often an efficacious remedy. The tendency to 
spasmodic attacks of this kind is much diminished by saturating the 
atmosphere of the room with steam from a steam-kettle. Attention to 
the regular action of the bowels is also important as a preventive, and 
Y. is usually desirable to administer a dose of castor oil in the morning 
after an attack has been experienced. 

[All the afore-mentioned expedients and even more are worth 
while to ward off these attacks, so distressing to infant and parents — 
sometimes almost frightfully so. Some infants have a constitutional 
(scrofulous) tendency which renders them unusually prone to them ; 
but whatever the causes, if they are counteracted or attended to so far ji.s 
possible, there is a preventive which has proved its power to ward off 
these acute spasms. It is the Magnetic Croup Tippet, which if placed 
about the child's neck at bed-time, and so worn steadily during crou- 
py seasons, protects croupy children effectually from such spasmodic- 
attacks. See page 1227.] 

Treatment of Bronchitis. — When bronchitis occurs, treatment 
similar to that employed when the wind pipe is affected should be con- 
tinued. Five to ten drops of ipecacuanha wine in a teaspoonful of 
glycerine should be given every three hours, and the chest and back 
should be well rubbed twice daily with some stimulating liniment. If 
the cough is severe, or the breathing at all impeded, diluted mustard- 
poultices should be applied occasionally to the chest ; and in the inter- 
vals between their application cotton-wool should be employed to cover 
the chest, the skin being rubbed gently with olive-oil or vaseline if 
much reddened by the poultices. The temperature of the room in 
which the child is confined should not be allowed to fall below 64° F., 
and especial care should be taken to maintain this temperature through- 



CHILD CROWING. 217 

out the night. The use of a steam-kettle is of much value in soothing 
a troublesome cough. For heating rooms in which children are con- 
fined suffering from cold or bronchitis, open fires are much preferable 
to gas stoves, which by drying the atmosphere occasionally add to the 
irritation of the lining membrane of the nose and throat. The injuri- 
ous effect of gas stoves can be modified by the evaporation of water in 
their vacinity, but under no circumstances are they comparable in 
value to open fires. 

ChildUCrowing. — The spasmodic attacks of false croup which 
have been already described have to be distinguished from another and 
somewhat similar affection from which children not unfrequentl v suffer 
during dentition, known as "child-crowing," or scientifically as Laryn- 
gismus stridulus. This child-crowing usually takes the form of a sud- 
den convulsive attack, appearing during apparent health, and arresting 
completely for a few moments the power of breathing. As the spasm 
passes off the breath is drawn in with a crowing or hissing sound, 
somewhat similar to what occurs in spasmodic croup. When a child is 
attacked with this form of spasm, it becomes suddenly stiff, throws its 
head backward, and becomes first pale and then livid in the face, with 
staring eyes and very alarmed expression. Occasionally there is at the 
same time some slight convulsive movements of the hands or feet. 
Sometimes for some days or even weeks before such an attack prelimi- 
nary symptoms are noticed in the form of occasional crowing or croaking 
in the breathing, the presence of which should always suggest recourse 
to medical advice. But such warnings are not by any means always 
present, and the attack may. and frequently does, come on without any 
preliminary indication of disease. Its distinction from spasmodic 
croup is easily made by the suddenness of the onset, the complete 
arrest of breathing, the tendency to convulsive movements, and the 
absence of cough. Attacks of child-crowing, if at all severe, are 
attended with considerable danger of sudden death ; and although one 
or two attacks may have only been slight, it can never be assumed that 
further ones will not be of a more dangerous type. Children showing 
any tendency to them should always be placed immediately under 
medical care, as much can be done to prevent their recurrence. 

Treatment of Ghild°Crowing. — For the immediate treatment of 
an attack when it occurs, the most convenient remedy is the applica- 
tion of a sponge wrung out of hot water to the throat, immediately 
under the chin. The inhalation of the vapor of ammonia is also 
useful in relaxing the spasm, and it is a good rule for mothers or nurses 
of children showing a tendency to child-crowing to always carry a 
bottle of ammonia salts in their pockets. If these remedies are not 
immediately effectual, the child should be placed as quickly as possible 
in a bath of about 98° F. 



218 DISORDERS WITH PROCESS OF DENTITION. 

These attacks are of a purely convulsive character, the spasm 
affecting certain muscles connected with respiration, and temporarily 
arresting their movement. Children during teething are subject also 
to convulsive attacks of a more general character, which are known 
usually as "fits," or general convulsions. 

General Convulsions, like the attacks above described, usually 
come on very suddenly, without any warning. The child is observed 
to become suddenly stiff, with eyes staring, neck thrown back, arms 
and legs stretched out and immovable, hands clenched, and breathing 
temporarily arrested. The eyes are often turned upward, so that 
very little but the whites are visible ; sometimes they are turned to one 
or the other side, so as to appear to squint. After a few seconds con- 
vulsive movements of the face, arms, and legs commence. The face, 
which usually becomes somewhat livid, is twitched in different direc- 
tions. The mouth is moved irregularly, and if the child has teeth the 
tongue may be bitten, and froth mixed with blood appear on the lips. 
The eyes usually roll from side to side, the eyelids being widely opened. 
The arms and legs twitch usually in a marked manner, the twitching 
sometimes affecting even the fingers and toes as well as the rest of the 
limbs. From the commencement of the attack the child is perfectly 
unconscious, and remains so during the whole course, and even fre- 
quently for some little time after it has ceased. When the spasmodic 
action ceases, the muscles relax, the child becomes pale, and may draw 
a long sigh, and gradually recovers consciousness. The duration of 
such a convulsive attack varies very much. A slight attack may not last 
more than one or two minutes, while a very severe attack may last as 
many hours. Generally speaking, when the attack is due to the irrita- 
tion of dentition, it will not be of long duration. 

Although the general convulsions just described seem in some 
respects much more severe than the limited attacks known as child- 
crowing, they are not so dangerous, or so often fatal in their results. 
General convulsions indeed, alarming as they appear, are very seldom 
fatal to life, unless their duration is of exceptional length. 

Treatment of General Convulsions. — The best immediate treat- 
ment is to place the child at once in a warm bath of about 98° F., keep- 
in o- it in the bath for five or ten minutes if necessary. When taken out it 
should be rolled in a warm blanket without being dried, and, if the 
convulsions are not entirely arrested, a large enema of warm water 
should be administered with a family syringe. Convulsions are very 
often associated with some disturbance of digestion, as well as with 
irritation from teething, and the evacuation of the bowel resulting from 
the enema is often followed by complete cessation of the convulsions. 

If the child has taken a meal shortly before the convulsive attack, 
an emetic of ipecacuanha should be given as soon as it is able to 



ABSCESS OF THE EAR. 2i9 

swallow, and, if this does not act quickly, vomiting should be excited 
bv tickling the throat with the finger. In doing this, care must be 
taken that the finger is not bitten by the child. 

General convulsions due to teething or other local irritation have 
no special tendency to recurrence after complete recovery, and unless 
•when of exceptional duration do not in any way permanently injure the 
child. Frequent recurrence would indicate the probability of some 
other and more serious cause for the attacks. 

Abscess of Ear. — One occasional cause of general convulsions 
which is sometimes overlooked, but which is not uncommon during 
the period of teething, is the presence of acute inflammation and abscess 
of the ear. This affection is often exceedingly painful, and gives rise 
to very persistent screaming in young children. The disease is not 
usually difficult of recognition in children old enough to describe their 
sensations ; but in children under two years of age it is often rather 
difficult of detection, until the nature of the case is made clear by the 
discharge of matter from the ear. The most characteristic signs of its 
presence are persistent loud crying, tossing of the head from one side 
to the other, and a tendency to raise the hand to the side of the head, 
an action not common under other circumstances. The painful stage 
of the disease usually does not last more than a day, the -pain disappear- 
ing when the matter is liberated from the ear. It is during the early 
part of the painful stage that convulsions are most likely to appear ; 
but their occurrence is not frequent in connection with this disease. 

Treatment of Abscess of Ear.— The pain of inflammation of the 
ear is best relieved by plugging the ear with a little cotton-wool 
steeped in laudanum, and applying warm fomentations over the out- 
side. The cotton-wool should be rolled into a thin cylinder, small 
enough to go into the opening of the ear, into which when dipped in 
laudanum it should be pushed gently as far as possible. Flannel 
wrung out of hot water should then be placed over the ear and covered 
with oiled silk or gutta-percha tissue. If convulsions occur, they must 
be treated as directed above. 

Night Terrors. — In children during the second dentition a pecul- 
iar kind of mental disturbance occasionally occurs, which is known 
under the name of night terrors. The child wakens up at night, suffer- 
ing apparently from some dreadful delusion, starts up in its bed, and 
screams violently. Occasionally it may even rise and rush out of the 
room. If observed immediately on waking it will be found not prop- 
erly conscious, remaining often for some little time in a self-absorbed 
and "dazed" condition of mind, evidently suffering from much alarm. 
The attacks are somewhat similar to those of nightmare, but differ 
from them in persisting for some time after awaking. Very exception- 
ally they occur during the day, when the child is awake and apparently 



2 2D DISORDERS WITH PROCESS OF DENTITION. 

well, some sudden illusion of sight alarming it, aDd throwing it tem- 
porarily into the same absorbed and trance-like frame of mind. These 
night terrors and analogous day disturbances are generally found asso- 
ciated with some disorder of digestion, and will usually disappear 
entirely if one or two doses of some mild purgative medicine are given, 
and due care is taken to prohibit indigestible articles of food. 

Mental Peculiarities during Second Dentition. — The mental 
health of children during second dentition is very unstable ; and it is 
not improbable that many acts of purposeless mischief, of motiveless 
naughtiness, of inexplicable deceit, in children of habitual good conduct 
and gentle disposition, committed at this period of life, are as truly 
involuntary reflex mental acts, as the muscular convulsions already 
described are involuntary physical acts, for neither of which can the 
child be properly considered responsible. 



CHAPTER XIX. 

Common Maladies of Children. 

J. Earache and Discharge from Ear. 2. Affections of Throat; Catarrhal In- 
flammation of Throat; Subacute Tonsillitis; Diphtheritic Inflammation; 
Distinction between them; Treatment of Catarrhal Inflammation, of Sub- 
acute Tonsillitis ; Precautions Relating to Diphtheria ; Chronic Enlargement 
of Tonsils; Their Effects on Respiration; Snoring. 3. Disorders due to 
Cold or Chill; Cold in the Head, in Throat and Larynx; Bronchitis; Cold 
affecting the Stomach and the Bowels. 4. Disorders of the Digestive Or- 
gans; Indigestion, Acute and Chronic; Diarrhoea; Prolapse of Bowel; 
Constipation; Treatment by Diet, by Injections, by Medicines. 5. Erup- 
tions on the Skin : Heat-spots; Roseola; Nettle-Rash; Eczema. 6. Infec- 
tious Eruptive Fevers : Chicken-pox; Small-pox; Scarlet Fever; Measles; 
Rptheln; Mumps; Whooping-Cough ; Responsibility of Parents in Relation 
to Infectious Diseases. 7. Parasitic Diseases: Ringworm; Itch; Thread- 
worms. 8. Diathetic Diseases; Rheumatism; Scrofula; Rickets. 

1 . Earache and Discharge from the Ear. — The occurrence of 
pain of a more or less acute character referred to the ear is not un- 
f requent in children, and is due usually to some inflammation affecting 
cither the external passage of the ear, or the middle ear, which is 
situated just within the drum. As has been already mentioned, it is 
sometimes associated with the period of dentition, but other causes, 
such as slight cold, disorder of the digestion, or inflammation of the 
throat, may also give rise to it. When the inflammation affects the 
external passage of the ear, its presence is usually indicated by some 
degree of swelling and redness, with tenderness to touch ; when the 
middle ear is affected, there are no external symptoms. The pain is 
often of a very severe character, and may continue for many hours, 
generally exhibiting paroxysms of acute exacerbations alternating with 
periods of partial relief. In a certain number of cases, complete relief 
is afforded in time by the discharge of matter which has formed as the 
result of the inflammation ; in others, the pain subsides gradually with- 
out the occurrence of any discharge. As a rule, it is not difficult to 
locate the pain as arising from the ear, but sometimes in children who 
have suffered from toothache, the pain of inflammation of the ear may 
be mistaken for that arising from decayed teeth. The presence usually 
of some degree of deafness in the affected ear will assist in the distinc- 

221 



222 COMMON MALADIES OF CHILDREN. 

tion ; sometimes the deafness may be very marked. Occasionally in- 
flammation occurs in the ear without any pain whatever, and its exist- 
ence is only recognized by the subsequent discharge, or by persistent 
deafness. 

The treatment of this affection is directed first to the relief of 
pain, and afterward to the maintenance of great cleanliness if any 
discharge results. Pain is best relieved by the application to the pas- 
sage of the ear of a little cotton-wool soaked in laudanum, over which 
may be placed, if necessary, some flannel wrung out of hot water and 
covered with oiled silk. The cotton-wool should be rolled into a little 
pledget, small enough to enter the passage of the ear, and long enough 
to project about a quarter or half an inch on the outside, so that it may 
be easily withdrawn ; the flannel should be large enough to cover the 
whole of the external ear. When the pain is very severe, the cotton- 
wool with laudanum should be changed every one or two hours. It is 
always desirable at the same time to administer some purgative med- 
icine, the good effect of which in relieving pain arising from the ear is 
often marked. Any convenient laxative medicine, such as sweet essence 
of senna or compound licorice powder, in suitable doses, may be em- 
ployed. When discharge occurs, the ear should be kept thoroughly 
clean by frequent syringing with warm water, to which it is generally 
desirable to add a little antiseptic fluid such as carbolic acid, of which a 
proportion of one teaspoonful to a glassful, makes a very eligible 
lotion for this purpose. A small india-rubber ball syringe is better 
than a glass one, as it admits of more gentle syringing ; and great care 
should always be taken that the syringing is performed as gently as 
possible, so as to avoid any risk of injuring the already inflamed and 
tender tissues. If the discharge continues for more than two or three 
days, it is well to have resort to skilled medical advice. The existence 
of discharge from the ear is always an indication of possible danger, 
not only to the hearing power of the ear, but also to the life of the 
child. The ear is in such close proximity to the brain that inflamma- 
tion of the one is somewhat apt to extend to the other ; and inflamma- 
tion of the brain is always a serious and often a fatal disease. It is there- 
fore most important never to neglect the existence of any discharge 
from the ear. An idea used to be prevalent that the arrest of discharge 
from the ear was attended with risk. The only foundation for such a 
belief is that it is undoubtedly dangerous to shut up the discharge in 
the ear by preventing it getting out ; but it is not in any way dangerous 
to prevent its formation by curing the disease from which it arises. 
The mischief which may arise from shutting in the discharge is sufficient 
reason for condemning strongly the common practice of keeping a plug 
of cotton-wool in ears affected with discharge. Such a plug is not only 
absolutely valueless, but may be a source of some danger. 



AFFECTIONS OF THE THROAT. 



223 



Short reference has been made to a form of inflammation showing 
itself only by the presence of deafness. Deafness resulting from this 
is apt to be progressive in character, and is difficult to cure in propor- 
tion to the duration of its existence ; those responsible for the health 
of children ought therefore to take the earliest opportunity of obtaining 
medical advice when its existence in any degree becomes apparent. 

2. Affections of the Throat. Description and Method of 
Examination. — If a child opens its mouth widely, and the view within 
is not obstructed by the tongue, the roof of the mouth will be seen to 
terminate behind in an arch, from the middle of which a pendulous 
piece of tissue is suspended, 
which is known as the uvula. 
At each extremity of the arch 
a projecting oval-shaped 
body will be observed, which 
forms part of the side of the 
mouth behind the teeth, and 
extends back toward the 
throat ; these are called the 
tonsils. The cavity seen be- 
hind these tonsils is known 
as the pharynx, which is con- 
tinuous below with the gullet. 
The windpipe opens out of 
the pharynx near its lower 
end in front. Not unfre- 
quently a clear view of the 
pharynx is impeded by the 
position of the tongue, which 
some children are unable to 
place voluntarily in such a position as to admit of the throat being well 
seen. The difficulty can usually be surmounted by causing the child 
to take a deep inspiration, while it pronounces at the same time the 
syllable "Ah," an action which depresses the tongue and dilates 
the throat, so that its condition can be thoroughly examined. When 
the child cannot or will not do this, some flat instrument, such as the 
handle of a spoon, should be laid on the tongue to maintain it in proper 
position. Sometimes the view of the pharynx is obstructed by en- 
largement of the tonsils, which may be of such a size as to meet in the 
middle line ; in such a case, when it is desired to examine the condition 
of the throat behind them, they must be separated by the flat handle 
of a spoon being pressed against the inner surface of each tonsil. 
Throats should always be examined in the best attainable light ; when 
daylight is available, the examiner should sit with his back to the 




THE NOSTRILS AS SEEN FROM BEHIND— BY A 
MIRROR IN THE THROAT— WHEN THE MEM- 
BRANES ARE PUFFED UP WITH CATARRHAL 
INFLAMMATION AND BREATHING IS IMPEDED. 
THE UVULA PROJECTS BELOW IN THROAT- 
ARCH. 



224 



COMMON MALADIES OF CHILDREN. 



light, while the child sits or stands facing it. The child's head should 
be thrown somewhat backward, so that the light falls into the throat 
over the head of the person making the examination. 

The throat in children is a particularly vulnerable part of the body. 
It is therefore well, in order to facilitate its examination during illness, 
for mothers and nurses to accustom children to open their mouths fully 
and exhibit their throats occasionally during health. When children 
have not been trained to do this, there is often an unpleasant struggle 
when inspection of the throat is necessitated by illness ; while, when 
habituated to show their throats properly^ not only inspection but any 
local treatment necessary can be effected with ease, and without dis- 
comfort to them. 

The throat is apt to become inflamed from simple cold, from dis- 
turbance of the stomach, from inhaling impure air, and from drinking 
impure water, as well as from various other causes affecting the 
general health ; and the character and seat of the inflammation not 
unfrequently give some clue to the special cause from which it takes 
its origin. It is proposed to describe here only three forms, which are 
sufficiently distinct usually to be easily recognized, while all are of 
moderately frequent occurrence. 

(a) Catarrhal Inflammation of Throat.— The first and most 
common form is known as simple catarrhal inflammation of the throat, 
and is generally due to exposure to cold. If suffering from this, a 
child who is able to talk will complain of a sense of dryness in the 
throat, with discomfort in swallowing, sometimes amounting to pain, 
and occasionally of pain shooting up into the ears. A younger child 
will show a disinclination to swallow, at the same time that it may 
exhibit a strong wish for food. It will commence sucking its bottle 
with avidity, but leave off almost immediately, often with a fit of cry- 
ing in which a little hoarseness may sometimes be noticed, although 
hoarseness is not a frequent characteristic of this affection of the throat. 
If the throat be examined in a good light, it will be noticed that the 
tonsils and the back of the pharynx are of a much darker red than usual, 
exhibiting a dusky hue, and being occasionally covered with rather 
adhesive mucus. The uvula also will sometimes be deepened in color, 
and occasionally somewhat swollen. As a rule, there is no external 
tenderness or swelling, but sometimes a little complaint may be made 
if the outside of the throat is pressed upon. 

(b) Subacute Tonsillitis. — The second form of inflammation of 
the throat affects mainly the tonsils, being known as subacute tonsil- 
litis ; this form is more frequently the result of irritation of the diges- 
tion, or of the inhalation of impure air, or the drinking of contamina- 
ted water. The amount of pain experienced in swallowing is not so 
great as in the catarrhal form, but there is a constant sense of dis« 



TONSILLITIS AND DIPHTHERIA. 



225 



comfort in the throat, and sometimes a desire to clear it by coughing. 
Generally some swelling can be perceived externally, just under the 
angle of the jaw on each side ; if it cannot be appreciated by the sense 
of sight, its presence is often demonstrated by that of touch, a small 
area of increased hardness being felt to project beneath the skin in the 
position mentioned. 

On inspection of the interior of the throat, both tonsils usually, 
sometimes only one, are seen to be enlarged, swollen, and reddened, 
and to project inward toward the uvula. Very commonly their inner 
surfaces will be seen to be dotted here and there with white points, 
varying in size from a pin's head to a split pea ; occasionally these 
surfaces will be entirely covered with a whitish-yellow deposit of a 
soft-looking and somewhat putty-like appearance. This deposit, which 
is strictly limited in area to the surface of the tonsils, not extending 
backward into the pharynx, or upward on the roof of the mouth and 
uvula, occasionally comes off in flakes, leaving a healthy red surface 
underneath. These characters serve to distinguish it from the deposit 
present in the third form of inflammation of the throat, diphtheritic 
inflammation, or diphtheria. 

(c) Diphtheritic Inflammation of the throat is apt to begin in a 
very insidious manner, often giving rise at first to only a very little 
discomfort. The child usually seems somewhat ill and out of sorts, 
with the temperature slightly raised, for a day or two before any com- 
plaint is made of local discomfort in the throat. When attention is 
called to the throat early in the disease, all that may be noticeable may 
be some very dusky red patches of inflammation scattered here and 
there on the tonsils, uvula, the roof of the mouth, or the back of the 
pharynx ; or, if the case is to be a severe one, the whole of the throat 
may appear of deeply red and angry-looking character. When seen a 
day or so later the red patches, or the throat generally, will be observed 
to be covered with a thin whitish membrane, smooth on the surface 
and sometimes almost glistening, which is surrounded with a deepened 
red border separating it from the healthy lining of the throat. As the 
disease progresses, the membrane becomes changed in color, altering 
from white into whitish yellow, then into deep yellow, and sometimes 
becoming gray, or even black. At the same time its surface loses its 
smooth and glistening appearance, and becomes somewhat roughened, 
opaque, and leathery. 

Distinction between Tonsillitis and Diphtheria.— Diphtheria 
is always a disease of serious import, requiring immediate skilled med- 
ical treatment, and it is accordingly very important to distinguish it 
from the comparatively benign affection of the throat already described 
as Subacute Tonsillitis, for which under some conditions it is apt to be 

mistaken. The distinction rests mainly on the character and appear- 
8 



226 COMMON MALADIES OF CHILDREN. 

unce of the exudation in tonsillitis, and on its strict limitation to the 
surface of the tonsils. In diphtheria the exudation never occurs in the 
form of small disseminated points over the surface of the tonsils. 
When it appears on the tonsils at all, it takes the form of one or more 
patches of varied size. The color of the patches of diphtheria on the 
tonsils is also different at first from the points of tonsillar exudation 
present in tonsillitis. Diphtheriyc patches are at first white and glisten- 
ing, while patches of tonsillar exudation are from the first of a dirty- 
yellowish color. The real difficulty in distinguishing the two is en- 
countered when the tonsillar exudation in subacute tonsillitis covers the 
whole surface of the tonsils. In such a case the throat presents a con- 
siderable resemblance to a diphtheritic throat, but the soft-looking, 
putty- like character of the exudation, its strict limitation to the surface 
of the tonsils, and the healthy appearance of the whole of the rest of 
the throat are generally sufficient to indicate the milder disease. A 
point of distinction occasionally available is the facility with which 
part of the tonsillar exudation can be sometimes scraped off with the 
handle of a spoon. Diphtheritic membrane can never be separated in 
this way, as it actually grows into the substance of the tissue on the 
surface of which it appears. The appearance of any patch of mem- 
brane on the roof of the mouth or on the back of the pharynx is con- 
clusive evidence of Diphtheria. 

[Colored illustrations of eight common throat diseases are to be 
found in Dr. Foote's New Book on Health and Disease, with Recipes. 
See advertising pages.] 

The Treatment of ordinary Catarrhal Inflammation of the 
Throat consists mainly in the maintenance of warmth, confinement 
to bed when any feverishness is present, and the application of sooth- 
ing remedies to the throat. Externally, water compresses usually give 
the most relief, applied from ear to ear, and renewed once or twice daily. 
If relief is not afforded by compresses, linseed meal poultices should 
be employed, changed as frequently as may be necessary. [And these 
poultices should be well spread or "buttered" with the Magnetic 
Ointment.] Internally, the sucking of small pieces of ice occasionally, 
or the sipping of small quantities of iced water, is most grateful. It is 
usually well to give a mild dose of laxative medicine, and the food 
administered should be such as can be swallowed with little pain, and 
is capable of easy digestion. Milk, farinaceous foods, lightly boiled 
eggs, and thickened soups or beef jellies fulfil well these conditions. 

Treatment of Subacute Tonsillitis. — In subacute tonsillitis the 
external application of water compresses or poultices is equally effective. 
Internally, the application of some astringent remedy with a camel's- 
hair brush two or three times daily is advisable ; glycerine of borax 
or glycerine of alum may be selected for this purpose. It is always 



PRECAUTIONS ABOUT DIPHTHERIA. 



227 



desirable to act well on the bowels of the patient with some suitable 
purgative, such as compound licorice powder or "black draught" 
(mistura sennse co.), in doses proportionate to the age of the child ; and 
care should be exercised in the choice of easily digested food. When 
feverish symptoms exist, the child should be kept in bed. 

It is out of place to say anything about the treatment of diphtheria ; 
it is a malady of so serious a character that any sufferer from it should 
always be placed as quickly as possible under the care of a medical 
practitioner. 

Precautions Relating to Diphtheria. — Diphtheria is a disease of 
exceedingly infectious character, and on the first suspicion of its pres- 
ence the patient should be most carefully isolated from the rest of the 
household. Its occurrence in any house ought always to excite suspi- 
cion of the probability of some defect in the drainage or the water- 
suppty, as it is especially prone to appear under such conditions ; and 
even if not due to either of these causes, the course of the disease is 
usually determined to a considerable degree by the sanitary conditions 
under which the treatment is carried out. 

There is some ground for believing that even ordinary catarrhal 
inflammation of the throat, and also subacute tonsillitis, are occasionally 
caught by infection, although generally due to other causes ; and 
although it is not usually thought necessary to isolate children suffer- 
ing from those affections, it is well to prevent such close contact as is 
involved in sleeping in the same bed with or in kissing other children. 

(d) Chronic Enlargement of Tonsils. — This affection of the ton- 
sils, which is sometimes known under the name of "hypertrophy of 
the tonsils," is not usually the result of inflammation, although tonsils 
permanently increased in size are perhaps more likely to become in- 
flamed than normal ones. The tendency to enlarged tonsils is often 
congenital, and not unfrequently affects the whole of the members of 
a famiiy. When the congenital tendency is present, the increase in 
size may appear at any age from one year up to thirteen or fourteen. 
Often the increase occurs by successive stages, the tonsils remaining 
for some time stationary in size, and as the result of some cold or other 
disturbance increasing rather rapidly, retaining their new and increased 
size for some time, and then again making another advance. The rec- 
ognition of enlarged tonsils, on inspection of the throat, is very easy. 
Tonsils normally project scarcely at all beyond the line of the mouth 
and throat, being seen simply as very slight protuberances, more 
noticeable on account of their difference of appearance from the rest of 
the throat than from their prominence. When they are enlarged to 
any extent, they project well into the throat, partly shutting off the 
view of the pharynx behind, and presenting the appearance of 
little tumors. Sometimes the hypertrophy is to such an extent that 



22S COMMON MALADIES OF CHILDREN. 

the tonsils actually touch each other in the centre of the throat. 
apparently blocking the passage altogether, and pushing the uvula 
forward out of their way. The hypertrophy sometimes affects only 
one of the tonsils, bat more frequently both are enlarged, although not 
uncommonly to unequal extent. Whatever the degree of enlargement 
may be, the color of the tonsils usually remain the same as in health. 

Effects of Enlarged Tonsils of Respiration. — Enlarged I 
are important chiefly in relation to the extent they may impede breath- 
ing through the nostrils. In themselves they are not a source of injury 
to health or of danger, as no amount of enlargement can ever induce 
dangerous symptoms ; but by impeding the breathing through the nos- 
trils, they not only are of ten the cause of considerable discomfo: 
pecially during the night, but in time not unfrequently give rise tc 
alterations in the shape of the chest, with resulting impairment of lung 
power. Even when the impediment to breathing may be slight, if it is 
in continuous action for months or years, the chest tends to give way 
under the increased work it has to do to draw in the proper amount of 
air; the sides of the ribs become drawn inward, the - bone pro- 

jects, and the condition results which when marked is known under the 
name of pigeon-breazt. 

"When the tonsils are hypertrophied. the breathing through the 
nostrils is impeded in two different ways. In the first place, the en- 
larged tonsils often project backward as well as inwurd, and thus 
encroach on the air-passage between the nostrils and the windpipe ; 
in the second place, their enlargement frequently give- to a little 

catarrhal inflammation of Ihe back of the nose and throat, accompanied 
- :ght swelling of the lining membrane and increas - retion of 
mucus, which still further contracts the ss ge. The 

first symptom which usually calls attention Liment of 

breathing arising from enlarged tonsils is persistent snoring at night 
Snoring only occurs when the mouth is kept open dur::. g slee] ; .nd in 
children at least this condition is abnormal, and always indicat - 
presence of some disturbing cause, the most frequent being en". _ 
ment of the tonsils. In advanced cases, during the c difficulty 

of nasal breathing may be observed, and the child will be noticed 
to keep its mouth open, and sometimes to make ad _ ble noise 
like very subdued snoring. 

When persistent snoring at night is remarked, it is always well 
to examine the condition of the throat. In considering the treatment, 
the main question to be decided is as to how much the enlarged tonsils 
themselves are the cause of the difficulty, and how fur it may be 
attributed to the resulting inflammation of the throat. When consider- 
able inflammation is indicated behind the tonsils by deepness of color 
and excess of mucus, if is well ! try to improve this by;, 



SNORING; CHILL AND COLDS. 229 

applications, such as glycerine of alum or of borax, made twice daily 
with a long camel's-hair brush, and to see if the breathing improves as 
the inflammation diminishes. When no improvement, or no sufficient 
improvement, results in two or three weeks, it is well to have the 
tonsils excised. This is a comparatively slight and painless operation, 
and its results are almost invariably thoroughly satisfactory. A con- 
dition which imperatively calls for this operation is the occurrence of 
deafness in either of the ears as a result of the secondary catarrhal in- 
flammation in the throat, unless the deafness disappears entirely by 
treating the catarrh with astringent applications. This form of deaf- 
ness is very insidious, generally being attended with no pain or dis- 
comfort whatever, and unless discovered early and treated properly, 
irreparable harm to the ear may result. When the existence of enlarged 
tonsils is known, parents and nurses should always be watchful for 
any symptoms of deafness. 

The treatment of enlarged tonsils, which are not of size sufficient 
to cause any difficulty in nasal breathing, is mainly directed to the pre- 
vention of further enlargement, and depending as it does on various 
constitutional considerations, as well as local conditions, does not fall 
within the scope of this work. Judicious medical advice is always 
required in those cases. [See pages 1224-26.] 

Snoring may result from other causes impeding breathing through 
the nostrils, as well as from enlarged tonsils. Catarrh of the throat, 
similar to that induced by enlarged tonsils, ma} r arise in other ways, and 
be present to such an extent as of itself to encroach to an injurious 
extent on the air-channel. Various diseases affecting the nostrils also 
give rise to it. The important point to be kept in view is that per- 
sistent snoring in children from any cause whatever indicates the 
presence of some impediment to breathing, and that the continuous 
presence of that impediment is certain sooner or later to do injury to 
the chest, and therefore to the lung-power of the child. Such injury 
is exceedingly difficult to rectify in later years ; it is therefore most 
desirable that the impediment should be medically treated, and if 
possible removed, at the earliest possible date after its recognition. 

3. Disorders Due to Cold or Chill.— In any climate where sudden 
changes of temperature are very common, various affections resulting 
from chill or from "taking cold "are naturally frequent. Different 
children manifest the results of a chill in different ways, and it will not 
unfrequently be observed that children belonging to one family show 
a family resemblance in their manner of exhibiting the effects of 
" taking cold." Some children, when chilled, invariably suffer from 
nasal catarrh, or cold in the head ; others as invariably are attacked 
with catarrh of the throat or windpipe, while others again manifest 
symptoms of bronchitis, or of irritation of the stomach or bowels. 



230 



COMMON MALADIES OF CHILDREN. 



Symptoms of Chill. — "Whatever form the cold is about to assume, 
it usually commences with a feeling of chilliness, some languor and 
disinclination for play, often some want of appetite, and frequently a 
desire for sleep. These symptoms are usually accompanied or im- 
mediately followed by some slight rise of temperature. In this 
respect children vary very much. Some, with apparently very slight 
cause, will show a rise of temperature of four or five degrees, their 
temperature rising to 102° F. or 103° F., while others seemingly much 
more ill will exhibit a rise of only one or two degrees, or even may 
have a temperature absolutely normal. The height of the temperature 
of a child is thus a very unreliable guide as affording a measure of the 
severity of an illness, unless the special temperament of the child is 
known beforehand. A much more important fact in children is the 
duration of an increased temperature. Even in slight illness a high 
temperature may be observed temporarily, but a high temperature 
continuing for more than twenty-four hours ought always to excite 
strong suspicion that something more than a cold exists. 

(a) Cold in the Head. — When the cold affects the head only, a 
feeling of fulness and stuffiness in the nose is experienced, with perhaps 
slight frontal headache in older children ; and breathing through the 
nostrils is much impeded, if not rendered quite impossible. This 
is accompanied by a discharge of watery mucus from the nostrils, 
which is often of an irritating character, causing redness and soreness 
of the upper lip. In a day or two the discharge becomes thicker and 
more yellow in color, at the same time losing its irritating character ; 
the stuffiness and difficulty of nasal breathing then diminish, and 
recovery usually results in a few days. 

(b) Cold Affecting Throat and Larynx. — The effect of cold when 
it affects the throat and causes catarrhal inflammation has already been 
described under " Affections of the Throat " at the beginning of this 
chapter. When its effect is manifested mainly in the upper part of the 
windpipe, or "larynx," as it is termed, the first symptom is usually a 
slight degree of hoarseness of the voice, often accompanied by a short, 
sharp cough, of what is known as a " croupy " character. The hoarse- 
ness may increase to such an extent that the child is only able to speak 
in a rough whisper, while the cough alters in character, becoming- 
hoarse, barking, and occasionally accompanied with some discomfort or 
even pain referred to the throat. There is very seldom any expectora- 
tion of any kind in this form of cold. Sometimes, in severe cases, there 
may be a little difficulty of breathing at night, showing itself in rather 
long-drawn acts of inspiration. There is never in this affection any 
difficulty in expiration. It is when suffering from this form of cold 
that children are sometimes affected by attacks of spasmodic croup, such 
as have already been described as occurring during dentition in Chapter 



BRONCHITIS. 231 

XVIII. The child, having fallen asleep comfortably, is awakened 
suddenly with a sensation of choking, starts up staring wildly and 
gasping for breath, and coughs almost continuously for some little 
time, with a short, noisy, hoarse cough, drawing its breath with diffi- 
culty in the intervals of the cough, and making a whistling, stridulous 
noise in doing so. When the attack is severe, the child is usually 
much frightened ; and if of long duration, the face often becomes 
swollen and livid. Generally, after a period varying from two or three 
minutes to half an hour, the spasmodic attack subsides entirely, and 
the child again falls quietly to sleep. Some children are specially prone 
again to such attacks, suffering from them to some extent with every 
access of cold affecting their larynx. 

This form of cold affecting the upper part of the windpipe is very 
apt to develop into bronchitis. When it does not do so, recovery is 
characterized by a gradual cessation of the croupy cough, and by the 
restoration of the healthy tone of the voice. When bronchitis results, 
it has the same character as when it occurs as the first manifestation of 
cold, with the addition that the hoarseness of the voice usually con- 
tinues to some extent until recovery from the bronchitis, and that the 
bronchitic cough is somewhat modified in character by the coexistence 
of the hoarseness. 

(c) Bronchitis, when resulting from cold, is usually indicated first 
by the presence of cough — dry, short, and resonant in character. The 
cough may be accompanied by some slight audible wheezing in the 
chest, which is best heard by placing the ear flatly against either the 
breast or back of the child. Sometimes there is a little increased fre- 
quency of breathing, but not to a notable extent, unless the bronchitis 
is severe. Occasionally, indeed, if the wheezing is very marked, the 
breathing may be somewhat slower than usual, some difficulty being 
experienced during inspiration. The distinction between the difficulty 
of inspiration in bronchitis from that sometimes occurring in cold 
affecting the larynx is easily made, as when the larynx is affected there 
is a distinct whistling, hissing noise while the breath is drawn in, which 
does not occur in bronchitis. If any noise exists during inspiration in 
bronchitis, it is of a wheezing character, easily recognized as coming 
from the chest. 

When bronchitis has existed for one or two days, the cough usually 
changes a little in character, becoming softer and looser ; and at the 
same time the wheezing usually diminishes or disappears, being suc- 
ceeded by moist gurgling sounds, as of air passing through fluid. 
When this stage is reached, older children generally begin to expec- 
torate a little mucus with the cough. This is at first usually white, 
gelatinous, and adhesive in character, gradually becoming more fluid, 
and more yellow in color, as recovery progresses. It is very seldom 



2^2 COMMON MALADIES OF CHILDREN. 

that children under fih - of age can he taught to expectorate. By 

the cough the mucus is thrown up into the throat, and while older 
children by voluntary effort bring it into the mouth and expectorate it, 
younger children involuntarily swallow it, and as a result often suffer 
from pain in the stomach and disorder of the bowels. Sometimes the 
cough may be severe enough to cause some vomiting and retching, 
which brings up both some of the mucus contained in the bronchial 
tubes and any that has been swallowed, and has remained in the 
stomach. "When the treatment of bronchitis is described, it will be 
seen that this natural method of evacuating the mucus is sometimes 
imitated by the administration of emetics. As recovery progresses the 
cough becomes less frequent, less rattling or bubbling is heard in the 
chest, and the expectoration, if any has been present, gradually 
diminishes. 

(d) Cold affecting the Stomach usually manifests itself in pain 
of an aching character localized in the pit of the stomach, with slight 
tenderness on pressure, sensations of sickness, sometimes amounting to 
actual vomiting, and distaste for food. Very seldom is headache com- 
plained of, the gastric disturbance due to cold in this respect differing 
from that which is the result of the ingestion of unsuitable food, when 
some degree of headache is generally present. If the tongue of the 
child be examined, it will usually be found somewhat furred, or else a 
little dry and of a brighter red color than usual. The disturbance of 
the stomach due to cold is apt to continue for some little time, showing 
occasional periods of improvement in which all sense of pain is lost, 
and again becoming more severe with a return of the pain. Its dura- 
tion is often materially increased by the administration of indigestible 
and improper food. 

(e) When the Bowels are affected by Cold the most frequent 
symptom is diarrhoea, with loose and watery motions. There may be a 
little pain and tenderness over the lower part of the abdomen, but this 
is often entirely absent ; when present it is not usually at all severe, 
and of only temporary duration. Xot unfrequently the affection of 
the stomach and that of the bowels occur sirnultaneou-.y. 

Of the affections here described as commonly resulting from cold, 
only one — bronchitis — is at all likely to assume a serious or dangerous 
character. Undoubtedly the paroxysmal attacks occasionally associated 
with inflammation of the upper part of the windpipe, the larynx, present 
often an alarming aspect, but they very seldom indeed are of such 
severity or duration as seriously to threaten the life of the child, and 
as a rule they are very amenable to suitable treatment. Bronchitis, on 
the other hand, especially in young children, and those of not very 
robust constitution, is very apt to assume a severe character, which 
often gives rise to much anxiety, and not unfrequently endangers life. 



THE TREATMENT OF COLD. 



233 



The symptom which most readily indicates seriousness and approaching 
danger is the rapidity and difficulty of breathing. Labored breathing 
in bronchitis is always a disagreeable symptom, and when this is com- 
bined with great quickness, and with perhaps some flushing of the 
face, or with much tendency to perspiration, anxiety should always be 
roused. In very young children the progress of bronchitis is some- 
times exceptionally rapid, and it is alwaj^s well to have recourse to 
medical assistance before serious symptoms become manifest, and in- 
deed when any symptoms of illness are present beyond slight cough 
and occasional wheezing. The continuance of feverishness after the 
first day of illness is always a feature calling for attention, as it may be 
the only apparent indication of some complication, such as the presence 
of limited areas of inflammation of the lung. 

The Treatment of Cold must be divided into that appropriate to 
the general earlier features, and that applicable to the individual mani- 
festations. When a child, by chilliness, fretfulness, and slight fever 
after a little exposure, shows indications of having taken cold, it 
should be placed in a warm bath of about 98° F., allowed to remain in 
it from five to ten minutes, then taken out and dried carefully in a 
warm room, and before a fire if the weather is at all cold, and placed 
in a bed previously warmed. When in bed and properly covered, some 
warm drink should be given, such as gruel or infusion of jam, or even 
a little warm wine and water. On the following morning the tem- 
perature of the child should be taken with the clinical thermometer 
before it is allowed to rise ; and if the thermometer registers a tem- 
perature above 99° F., it should be kept in bed for the day. The diet 
should be made as light as possible, consisting mainly of milk, bread 
and milk, farinaceous puddings, and animal broths ; and the child 
should be induced to drink a irood deal of fluid in the form of milk, 
barley-water, rice-water, or lemon and water without much sugar. If 
the bowels have been in the least degree confined, their action should 
be promoted by the administration of some sweet essence of senna or 
some compound licorice-powder. When the cold affects only the head, 
very little beyond this general treatment is required. The comfort of 
the nose is promoted by occasionally applying to it a sponge squeezed 
out of hot water ; after which it should be dried with a handkerchief, 
and anointed with vaseline [or Magnetic Ointment]. The application 
of vaseline to the interior of the nose with a camel's-hair brush is also 
soothing, and comfort is sometimes derived from inhaling through the 
nostrils the steam arising from very hot water. The skin of the upper 
lip should be protected from irritation arising from the discharge from 
the nose by the application nightly of zinc ointment or of cold cream. 

The local treatment of catarrhal inflammation of the throat has 
been already described under Affections of the Throat. 



UMON MALADIES OF ^HILDREX. 

Treatment of Cold Affecting the Larynx.— When the larynx is 
the seat of inflammation, the frequent inhalation of the vapor arising 
from hot water is of much value. No special apparatus is required for 
this, as an ordinary hot-water jug answers perfectly. The jug should 
be half filled with water almost boiling, and the head held a few inches 
above the mouth of the jug while the steam is inhaled. If a large 
handkerchief or a towel is thrown over the head and gathered round 
the edge of the jug, the steam is prevented from dissipating, and the 
inhalation is more effective. When any special inhaler is employed, 
the water must not be quite so warm as when the vapor is inhaled 
from an open jug ; with most inhalers, a mixture of two parts of boil- 
ing water to one part of cold water will be found of a suitable tem- 
perature. In these cases the external application of warm linseed- 
meal poultices, or weak mustard-poultices, is very grateful and soothing. 
The poultice should be tied on round the neck so as to cover the whole 
of the front part, and should be changed as often as it becomes cool. 
[It will be more effective if well covered with the Magnetic Ointment, 
so that this comes in direct contact with the surface of the skin.] If the 
cough is troublesome, five to ten drops of ipecacuanha wine may be given 
in a teaspoonf ul of glycerine every four hours. Spasmodic attacks of so- 
called false croup, which occur chiefly during the night, are best 
treated by the application to the throat of a large sponge squeezed out 
of hot water, followed if necessary by a warm bath of 98° F. as soon 
as it can be prepared. The inhalation of steam is also most useful. 
When these means fail in arresting the attack, which very seldom 
happens, the administration of an emetic in the form of one or two 
spoonfuls of ipecacuanha wine is almost invariably successful. 

Treatment of Bronchitis. — Bronchitis is most successfully treat- 
ed, when slight, by the application once or twice a day of a stimulating 
liniment to the chest and back. Eligible liniments for very young 
children are camphorated oil (liniment of camphor), for older ones 
liniment of turpentine, and of mustard. [The Magnetic Ointment, 
with its combined counter-irritant and soothing properties is the best 
local remedy for young or old.] 

To insure the efficacy of such liniments they should be rubbed 
well into the skin of the chest and back with much friction of the 
hand, five or ten minutes or even longer being given to the process. 
The chest should then be covered with a sheet of cotton-wool, or pro- 
tective tissue such as " Gamgee " tissue, which consists of a layer of 
cotton-wool enclosed within two layers of thin gauze ; this may be 
maintained in position by one or two turns of a thin flannel bandage. 
When the cough is very frequent and troublesome, the constant applica- 
tion of linseed-meal poultices may "be found more effective in allaying 
the irritation. These should be applied as warm as can be borne, both to 



TREATMENT OF STOMACH COLDS. 235 

the back and to the front of the chest, and should be changed as often 
as may be necessary to maintain their heat continuously. If the skin 
to which they are applied becomes tender or irritable, a little olive-oil 
should be poured over the surface of the poultice before its application ; 
or if necessary the poultices may be intermitted for some hours, while 
the irritation is soothed by inunction of vaseline or olive-oil, and the 
chest protected by cotton-wool or Gamgee tissue. The most useful 
internal remedy is ipecacuanha wine, given in doses of from five to ten 
drops in a teaspoonful of glycerine every three or four hours. Very 
young children often experience much difficulty in coughing up the 
mucus which collects in the bronchial tubes, and evidence of its accumu- 
lation there is afforded by sounds of rattling and bubbling within the 
chest. In such cases the breathing is facilitated and the cure expedited 
by the administration of an emetic, in the form of one or two teaspoon- 
fuls of ipecacuanha wine, given once or twice in twenty-four hours if 
necessary. The vomiting thus induced causes the evacuation from the 
bronchial tubes of most of the mucus accumulated there, and also 
gets rid of any which may have been coughed up and swallowed. It 
has already been remarked how little discomfort is caused to young 
children by vomiting, and they will often be observed looking quite 
bright and happy within a few minutes after the emetic has acted. 

In all cases of bronchitis it is most important to maintain a 
proper temperature iu the room throughout the night. Many cases 
of bronchitis are indefinitely prolonged by neglect of this precaution. 
A temperature of at least 60° F. should be kept up in all cases ; some- 
times even a nigher one of from 64° F. to 66° may be of much value. 

When Cold affects the Stomach great care should be given to 
the diet of the child, which should consist exclusively of milk, light 
milk puddings, and veal-tea or chicken-tea. If much sickness is present 
it may be necessary to abandon the milk for a day or two, and to give 
simply veal-tea, chicken-tea, and barle}'-water. Great relief is usually 
afforded by a succession of mild mustard-poultices to the pit of the 
stomach, the poultices being made of such a strength as to maintain 
some degree of redness of the skin. Usually a strength of one part of 
mustard to five or six parts of linseed-meal will suffice to effect this. 
[The Magnetic Ointment will generally be found preferable to mustard- 
poultices, and easier to manage.] When thirst is a troublesome symp- 
tom, very small quantities of cold water or barley-water may be given 
as often as desired, not more than from one to two teaspoonfuls of cold 
water, or twice that quantity of barley-water, being allowed at one 
draught. As the pain subsides, greater liberality iu diet may be 
allowed, the child returning gradually to its ordinary diet ; but for 
some little time care must be taken to prevent the ingestion of any- 
thing at all likely to prove difficult of digestion. 



236 COMMON MALADIES OF CHILDREN. 

If Diarrhoea is present fomentations with flannels, wrung out of 
hot water, are usually more agreeable than poultices, as they are lighter 
when spread over a large surface. Special care in feeding is essential, 
and often complete abstinence from all food except chicken or veal 
tea, and barley-water, for twenty-four hours, will result in complete 
cure. When a cold has affected either the stomach or bowels, care 
should be taken for some little time afterward to clothe the child 
warmly ; it is often advisable in cold weather to specially protect the 
abdomen with a warm flannel binder. 

4. Disorders of the Digestive Organs. — (a) Acute Indiges= 
tion. — Indigestion in children occurs both as an acute and as a chronic 
affection. In its acute form it is most frequently characterized by sen- 
sations of sickness, vomiting, headache, and occasional pain in the pit 
of the stomach, without any marked rise of temperature. When these 
symptoms present themselves, the absence of fever, as indicated by a 
normal temperature, is of much importance, as many acute diseases 
begin with sickness and headache, but almost always exhibit as well an 
increase of temperature. When the attack is very sudden, and has 
been caused by the ingestion of some improper article of food, the 
offending material may often be detected in the vomited matter. 

Acute indigestion is probably always the result of eating improper 
food, but sometimes the symptoms do not set in immediately after the 
food has been taken, so that it is occasionally difficult to trace the cause. 
If the stomach has been slightly irritated for some time by food not 
easily digested, a very slight cause may be sufficient to initiate a severe 
attack of acute indigestion. In very young children the attack not un- 
frequently commences with convulsive fits ; and it is always well when 
such fits occur in children to inquire carefully what articles of food 
they have recently had, as a clue to the cause of the fits and their 
treatment is often thus afforded. 

When the stomach has been thoroughly emptied by vomiting, 
there results usually very considerable relief, although a slight sensa- 
tion of nausea with some amount of headache will usually remain, dis- 
appearing entirely after a night's rest. 

In a less acute form indigestion presents itself in the form of 
aching pain in the pit of the stomach, with slight feelings of nausea, 
some disinclination for food, perhaps a little headache, and a tendency 
to lassitude and irritability of temper. Many children are very prone 
to attacks of this kind, which are caused usually by some unwonted 
article of food, or some excess in quantity ; and although if properly 
attended to they are of short duration, and of comparatively little im- 
portance, if neglected they are apt to lead to a chronic irritable con- 
lition of the stomach, which may materially impair the general health. 

(b) Chronic Indigestion is of rare occurrence in children, except 



INDIGESTION; DIARRHCEA. 237 

as a result of a chronically irritated condition of the lining membrane 
of the stomach, known to medical men as chronic gastric catarrh. 
When indications are noticed in a child of gastric disturbance continu- 
ing for some time, in the form of want of appetite, occasional pain in 
the pit of the stomach, slight headaches affecting chiefly the forehead, 
tendency to flushing of the face after meals, sudden attacks of pallor, 
restlessness at night, and talking in the sleep, there is a strong prob- 
ability of the existence of chronic gastric catarrh, and medical advice 
should be sought. The cure is almost always rather tedious, and 
necessitates much attention both to diet and to climatic conditions. 
[See page 1226.] 

Treatment of Indigestion. — Acute indigestion usually requires 
very little treatment. If the stomach is not thoroughly evacuated by 
vomiting, an emetic of one or two teaspoonfuls of ipecacuanha wine 
should be given ; or sickness may be produced by irritating the back of 
the throat with the finger. After the sickness has subsided, some laxa- 
tive medicine should be given, to remove from the bowel any of the 
irritating material which may have lodged there ; in most cases the 
preferable purgative is castor-oil, given in a dose of one or two tea- 
spoonfuls, according to the age of the child. Complete rest should be 
given to the stomach for a few hours afterward, only a little water 
or barley-water being given if thirst is present ; and when food is 
again allowed, it should be of the lightest and most digestible character. 

When the acute indigestion has given rise to convulsive fits, the 
child should be placed at once in a warm bath, and whenever an arrest 
of the convulsions takes place, efforts should be made to induce sick- 
ness by the administration of ipecacuanha wine, or by tickling the 
throat with the finger ; after which a large enema of warm water 
should be given, and the child then allowed to remain for some hours 
lying in warm blankets, and without any food. 

The treatment of chronic indigestion should always be carried out 
under competent medical advice. 

(c) Diarrhoea in children, when not the result of chill, is usually due 
to irritation of the bowel from some improper food. When it is slight, 
it may be regarded merely as a somewhat exaggerated effort of the 
bowel to get rid of obnoxious contents, .and should not be interfered 
with. It is apt, however, to go rather beyond what is necessary for 
the mere discharge of the offending material, and to continue for some 
time after it has been expelled. The attention to be given to diarrhoea 
depends mainly on the frequency of the motions, on the presence or 
absence of pain, and on the duration of the malady. If in one day the 
number of motions in an infant exceeded eight or ten, or in a child of 
four or live years old exceeded six or eight, it would generally be 
desirable to resort to some remediable measures ; and the presence of 



238 



COMMON MALADIES OF CHILDREN. 



pain of a colicky character would more urgently call for tkern. The 
continuance of such frequency of action for forty-eight hours would 
undoubtedly call for some attention ; and any degree of frequency be- 
yond what is stated above continuing for two days in an infant under 
one year old would arouse some amount of anxiety ; while at the age be- 
yond that it would be followed by some temporary depression of health. 

The Treatment for Diarrhoea due to the ingestion of improper 
food consists of evacuation of the offending matter as rapidly as 
possible by the administration of one dose of castor-oil in quantity 
suitable to the age of the child, abstinence for a day from all food 
except animal broths and barley-water, and, in the case of young 
children, rest and warmth in bed. [Externally apply, without rubbing, 
the Magnetic Ointment ; and internally, give Magnetic Cramp Tablets. 
See page 1228.] 

(d) Prolapse of the Bowel not unfrequently occurs in children 
as a result of diarrhoea of some duration ; sometimes, on the other 
hand, it happens as a consequence of persistent constipation In both 
cases it is directly due to straining on the part of the child in order to 
evacuate the bowels. When diarrhoea has continued for a little time, 
the lower end of the bowel becomes irritable and swollen, and even 
when the bowel has been completely emptied, a sensation is experienced 
by the child of incomplete evacuation ; it accordingly strains with the 
object of effecting this thoroughly, and as a result the somewhat 
swollen bowel projects a little way through the opening, and remains 
extruded for some time. The everted bowel forms a purplish- red 
swelling, varying from the size of a thimble to that of a Tangerine 
orange, at the opening of the bowel, and is readily distinguished from 
any other swelling by its very sudden appearance, and by the presence 
of an opening in its centre. The straining which constipation occasion- 
ally induces, in the attempt to evacuate the bowel, acts in a very 
similar manner in causing prolapse. In all cases, probably, the lining 
of the bowel near the opening becomes first a little inflamed and swollen, 
and, losing its elasticity, lends itself more easily to the extrusion. 
When prolapse has occurred once or twice under circumstances of 
irritation, it is very apt to happen afterward when the bowels move in 
a normal manner, and may even take place when the child is standing 
or walking, without any action of the bowels. It gives rise to some 
degree of discomfort, which may speedily increase to pain unless the 
prolapse is returned into the bowel. When the prolapse is slight, it 
may return after a few minutes without any assistance, but, as a rule it 
is necessary to aid it by some gentle pressure upward. The most simple 
and easy method of returning the prolapsed bowel is to cover the little 
finger with one fold of a thin towel or handkerchief anointed with some 
vaseline [or Magnetic Ointment), and to push the point of the finger, 



CONSTIPATION. 239 

covered by the towel, into the opening apparent in the middle of the 
prolapsed bowel. If the finger be pushed well upward the bowel will 
be found to recede within the opening ; and when it has regained its 
proper position the finger should be drawn carefully from inside the 
covering towel, which is drawn out of the opening gently, after re- 
moval of the finger. If prolapse occurs frequently, much care must 
be taken in the diet of the child to prevent either diarrhoea or con- 
stipation, and the child must be watched during evacuation of its 
bowels in order that no unnecessary straining may be permitted. When 
children are in good health otherwise, a cold bath every morning is of 
value in strengthening the lower end of the bowel, and obviating the 
tendency to prolapse. 

(e) Constipation of the Bowels consists not only in insufficient 
frequency of their action, but also in an abnormally hardened condition 
of the motions on evacuation. The normal frequency of action varies 
very considerably in different children, as it does at various ages. In 
babies under six months old the bowels usually act three or four times 
daily ; between six months and a year from two to three times ; and 
between one and two years old about twice daily. After two years of 
age one motion daily is the most usual, but some children have regularly 
evacuations twice every day, and even three may occur during the day 
without any apparent deviation from health, although this number is 
very uncommon. On the other hand, some children have only one 
motion every second day, although in perfect health. Constipation 
may be considered to be present when the motions are abnormally hard 
in character, and occur not more frequently than once daily. It is ex- 
ceptional, how T ever, for a daily motion to occur regularly when the 
motions are unusually hard ; generally it will be found that one motion 
occurs only every second or third day. One reason for this is that the 
passage of a hard motion often involves some discomfort or even pain 
to the child, and it accordingly postpones as long as possible the effort 
to evacuate ; another reason is that when hardness of the motions has 
existed for some little time, the extremity of the bowel loses its 
sensitiveness to indications calling for relief, and the healthy evacua- 
tion is inadvertently postponed. These two reasons afford a key to 
part of the treatment necessary for constipation. 

Diet in Constipation. — The existence of constipation in an other- 
wise healthy child is generally an indication of the necessity of some 
alteration in its diet. The digestive power of children for different 
articles of diet varies greatly, and a diet which tends to excite diarrhoea 
in some may be insufficient to prevent constipation in others. It is not, 
therefore, possible to indicate any definite diet which will insure free- 
dom from constipation, but some suggestions may be offered as to the 
direction in which alteration* of food should be made. 



240 COMMON MALADIES OF CHILDREN. 

Xot unfrequently a diet which consists too exclusively of milk, 
and foods made with milk, is associated with constipation. In such 
cases the addition of some animal broths, and of eggs lightly boiled or 
poached, may be of much value. 

When only light and prepared farinaceous foods, or the prepared 
malted ones have been employed, the substitution of oatmeal or of 
Robinson's groats may facilitate the regular action of the bowels. In 
young children airy change of food should be made with caution, and 
the effect watched. When children have reached the age of one year, 
a little stewed fruit, such as prunes or apples, may be added to the diet, 
or a small quantity of well-cooked green vegetables, such as cauli- 
flower or spinach, may be permitted. The addition of a little fat to 
the diet in the form of cream, butter, or a little fried fat bacon, is 
often very useful in combating the constipation of the bowels. Cod- 
liver oil in small doses is often used for this purpose with much advan- 
tage. Sometimes undue dryness of diet is the source of the irregularity 
of the bowels. The child perhaps takes some farinaceous food for 
breakfast, a little fish or pudding for dinner, and again something 
farinaceous in the evening, and during the whole day drinks no fluid 
beyond what is contained in the food supplied. In such cases the 
addition of fluid to the diet in the form of milk, milk and water, or 
plain water, may result in much improvement. In older children the 
diet must be varied as much as possible consistently with the digestive 
capabilities of the child, articles of diet of a laxative tendency being 
selected, such as oatmeal, green vegetables, fruits, both cooked and un- 
cooked, and fats, and given along with, or in place of, the more simple 
articles of food appropriate to children's diet. Much assistance in the 
treatment is usually effected by the daily administration of a cold bath, 
followed by friction of the skin with a warm towel. 

Importance of Habit. — Of very great importance in the treat- 
ment of constipation is the inculcation of a habit of soliciting on action 
of tlie bowels daily at a fixed hour, and devoting at least five minutes to 
this operation, Reference has already been made to the utility of this 
practice in inducing regular action of the bowels, and its importance 
is emphasized by the consideration, mentioned as one of the causes of 
constipation, that the hardness of the motion tends to cause some 
insensibility to the call for reliel Mention has also been made there of 
the tendency of children to postpone the evacuation when constipation 
exists, on account of the discomfort arising from the hardness of the 
motions ; an additional reason for regularity being thus afforded, as the 
hardness and consequent discomfort are only increased by the delay, 
while at the same time the sensibility of the bowel is diminished. The 
sensibility is also diminished if the evacuation is only incomplete, and 
care should be taken that time is given to empty the bowel. 



REMEDIES FOR CONSTIPATION. 241 

Enemas. — When alteration of diet, together with regular solicita- 
tion of action, is insufficient to relieve altogether the constipation, some 
assistance must he afforded, either by applying locally a stimulus to the 
bowel, or by the administration of some laxative medicine. The most 
convenient stimulus to the bowel for this purpose is afforded by the 
injection of one or two teaspoonfuls of glycerine with the aid of a 
small vulcanite syringe, such as is described in Chapter IV. Usually 
within five or ten minutes after such an injection the bowels act freely 
and effectively, and the injection, if successful in its action, may be 
repeated daily, or better, on alternate days, without any risk of weaken- 
ing or injuring the bowel. When the stimulus of the glycerine is not 
sufficient to produce adequate action, an injection of three or four 
ounces of cold water should be employed. This also, like the injection 
of glycerine, may be repeated when necessary without fear of injury. 
It is generally advantageous to repeat such injections only on alternate 
days, affording the bowel an opportunity every second day of acting 
properly without artificial stimulus. 

Laxative Medicine. — When it is found that even with daily action 
of the bowel induced by artificial stimulus, and with the aid afforded 
by appropriate alteration of diet, the motions still continue to be of 
abnormal hardness, some internal medicine must be resorted to, in 
order to modify and increase the secretion from the lining membrane 
of the bowel. To this end recourse may be had to the occasional 
administration of sweet essence of senna, compound licorice powder, 
or sulphur in the form of lozenges, in doses suitable to the age of the 
child. It should always be borne in mind, however, that the employ- 
ment of drugs for this purpose should be resorted to as seldom as 
possible, as the bowel becomes quickly habituated to them, and the 
digestive power is apt to be weakened by their frequent use. 

5. Noninfectious Eruptions on the Skin. — Eruptions of 
different kinds occur frequently in children, the skin during the 
earlier years of life being very sensitive, and sympathizing in this way 
with various disturbances of the general health. Some of these are 
associated with, and apparently dependent upon, some disorder of the 
digestive organs, and are not infectious in character ; others form the 
external manifestations of what are known as essential fevers, and 
indicate diseases of an infectious nature ; wdiile a third class again are 
due to irritation of the skin from external sources. Some of the more 
simple non-infectious eruptions will be first described. 

(a) Heat=spots (Erythema papulation). — These spots, although 
not unfrequently due to the irritation associated with dentition, more 
frequently result from some disorder/of digestion, such as may be pro- 
duced by an excess of animal food in the diet, or an inordinate 
quantity of sugar. Rarely they are caused by flea-bites. They take 



242 COMMON MALADIES OF CHILDREN. 

the form of disseminated red elevated spots, in size varying from a split 
pea to a threepenny piece [half dime], slightly hard to touch, irritable 
and itching, and each surrounded by a small circle of reddened skin. 
Usually they occur in clusters, but sometimes singly ; and their favorite 
sites are the legs, arms, thighs, back, and shoulders. Their appearance 
in the face is exceptional. The spots usually appear suddenly without 
any warning or indication of illness, remain red and irritable for one 
or two days, and then fade and disappear gradually, while other fresh 
ones come out on other parts of the body. Successive crops may con- 
tinue in this way for several weeks, or, in fact, so long- as the disturb- 
ing disorder of digestion persists. "When the eruption is severe, some 
of the spots occasionally have a small vesicle of fluid on their apex, 
which dries up as the spots subside. The recognition of heat-spots is 
not usually difficult, as their appearance is almost characteristic. The 
one disease for which sometimes they are mistaken is chicken-pox, and 
then only when the small vesicles on the apex of the spots are excep- 
tionally apparent. The points of distinction are that in heat-spots the 
elevated red spots are large and somewhat hard and any vesicles pres- 
ent very small, while in chicken-pox some of the vesicles are usually 
rather large, the surrounding redness very small, or even absent 
altogether, and the hardness entirely absent ; that heat-spots generally 
occur in clusters, and are often limited to one arm or one leg or other 
situation on the body, while the vesicles of chicken-pox are always 
disseminated over the whole body, including as a rule a few on the 
face ; and that the vesicles of heat-spots when present tend to shrivel 
and disappear within twenty-four hours, while those of chicken-pox 
usually increase in size for one or two days. It is only indeed within 
the first twenty-four hours of their appearance that any mistake can be 
made, and the most common error is in mistaking chicken-pox at its 
commencement for heat-spots than the converse. Further points of 
distinction in this early stage will be given when chicken-pox is 
described. 

The Treatment of Heat=Spots should be directed to the removal 
of the disturbance to which their appearance is due. If the irritation 
of teething appears to be the cause, attention should be paid to the 
condition of the mouth, and mild laxative medicines, such as sweet 
essence of senna, or fluid magnesia, should be given, as suggested in 
the chapter on Disorders connected with Dentition. When the diges- 
tion appears in fault, which may be assumed to be the case in the 
absence of any disturbance due to teething, any apparent error in diet 
must be corrected, the frequent association of the heat-spots with a 
rich meat diet, with "heating" (highly nitrogenous) articles of food 
such as oatmeal, and with excess of sugar, being specially kept in view. 
In addition to alteration, and occasionally reduction in quantity, of 



d 



ROSEOLA OR ROSE-RASH. 



243 



iet, it is generally well to act on the bowels slightly by giving a mild 
aperient every second night, fluid magnesia in appropriate doses being 
eligible in such circumstances. The most soothing local applications 
for the irritation of the spots, Avhich is apt to be especially trouble- 
some at night, are vaseline, cold cream, and Goulard water mixed with 
milk in equal portions. 

(b) Roseola or Rose=rash is an affection of the -skin of very 
slight importance, and usually of very temporary duration, due to 
some slight disturbance of the digestive system. It occurs in the form 
of a rose-colored rash, covering sometimes the whole, sometimes only a 
part, of the body, which on careful examination is seen to be made up 
of innumerable small crimson spots, separated from each other by 
narrow intervals of healthily colored skin. The spots vary in size con- 
siderably in different cases, sometimes being very little larger than a 
large pin's head, at other times attaining a size larger than a split pea. 
The intervals of healthy skin differ in size also, sometimes being so small 
that the eruption presents on superficial examination the appearance of 
uniform flushing of the skin, the individual spots only becoming fully 
apparent on more careful observation ; while in other cases each spot 
is very distinctly surrounded with an area of normal color. The 
eruption is accompanied by very little or no rise of temperature, but 
there are usually some signs of disordered digestion in the form of sen- 
sations of nausea, disinclination for food, and slightly coated tongue. 
As a rule, it continues for one or perhaps two days, disappearing some- 
times somewhat suddenly, in other cases more gradually. 

Rose-rash is noteworthy mainly on account of its liability to be 
confounded with measles on the one hand, and with scarlet fever on 
the other. When the spots are large and distinctly separated, they 
resemble very closely the eruption of measles ; when very small and 
closely aggregated, the resemblance to scarlet fever is equally striking. 
The differential diagnosis has therefore to rest chiefly on other points 
than the appearance of the eruption, although slight differences in 
color afford sometimes a distinction of some value. 

The distinction from measles is made chiefly by the occurrence of 
the eruption in roseola without any preliminary symptoms of illness, 
the absence of fever, and of watering of the eyes, cold in the head, and 
cough, such as are usually present at the commencement of measles, 
and the altogether slighter character of the illness. In measles also the 
eruption is nearly always most developed on the face, where it appears 
first, spreading from there downward over the whole body ; in roseola 
it does not always cover the whole body, and is seldom well marked on 
the face, being most distinct usually on the chest or abdomen. These 
distinctive points, together with the fact that isolated cases of measles 
&re rare, the disease commonly occurring in epidemics, are usually 



244 COMMON MALADIES OF CHILDREN. 

sufficient to make the differentiation between rose-rash and measles 
easy. It is much more difficult, when roseola assumes the form of 
eruption similar to scarlet fever, to distinguish it from slight cases of 
that very infectious disease. The color of the eruption sometimes aids : 
in roseola it is of a crimson or rose color usually, while in scarlet fever 
it is distinctly scarlet. These shades, however, tend to approximate, 
and it is sometimes very difficult, in either of the diseases, to say 
whether a particular eruption should be called crimson or scarlet. 
When the individual shade is distinctly marked, however, it is of con- 
siderable value as a differential sign. In roseola there is very seldom 
any tenderness of the throat complained of, although sometimes it may 
be slightly reddened ; in scarlet fever there is generally some sense of 
dryness of the throat and discomfort in swallowing. The presence of 
much fever, and especially its duration for more than twenty-four 
hours, is strong evidence in favor of scarlet fever. Marked flushing 
of the face also points strongly to scarlet fever, and a somewhat dry 
injected condition of the white part of the eyes is very characteristic 
of that disease. The eruption of scarlet fever, like that of roseola, is 
not unfrequently partial, and most marked upon the chest rather than 
the face ; but a valuable point of distinction, when present, is found 
in the fact that the eruption of scarlet fever, even when faint in other 
parts of the body, is often well marked in front of the elbow and fore- 
arm and behind the knees, while roseola is very seldom or never well 
marked on the limbs without appearing distinctly also on the body. 
In some cases the difficulty of distinction at first sight is insurmount- 
able, and observation of the progress of the illness for twenty-four or 
forty-eight hours is necessary in order to arrive at a certain diagnosis. 
If the disease be scarlet fever, the fact is then usually made sufficiently 
apparent by the persistence of fever, the increase of discomfort of the 
throat, and the duration of the eruption. 

Roseola calls for very little treatment. If no fever exists, it is not 
necessary to confine the child to bed, but its diet should be regulated 
carefully, only light and easily digested food being allowed, and some 
slight aperient, such as effervescing citrate of magnesia or sweet essence 
of senna, should be given. If there is any suspicion that the disease 
may be scarlet fever, and not roseola, the child should be rigidly 
isolated from others until a positive diagnosis is arrived at. 

(c) Nettle=rash {urticaria) is another affection of the skin, which 
although yery troublesome and irritating, is of no serious importance 
regarded from the view of the general health of the child. It is 
usually of very temporary duration, but is somewhat apt to reappear 
at intervals, for two or three days after it has first manifested itself. 
It is generally due to the ingestion of some article of food which may 
not be in the least degree difficult of digestion by most children, but 



URTICARIA OR NETTLE-RASH. 



245 



which m some way is especially irritating to the individual child 
affected. Among articles of food specially prone to excite nettle-rash 
in some children are various shell-fish, such as oysters, mussels, crabs, 
and lobsters ; some fruits, especially perhaps strawberries ; cured meats, 
including sausages and smoked tongue ; and fresh pork. Some chil- 
dren are very liable to nettle-rash, in some cases probably having a 
hereditary tendency to it, and suffer from an attack whenever the 
stomach is at all disordered by their having eaten some indigestible 
food. The eruption, which may be generally distributed over the body 
and face, but which is more usually very partial, often affecting only a 
very limited area, takes the form of irregularly shaped red blotches, 
somewhat elevated from the surrounding skin, and usually surmounted 
by a patch of exceptionally white skin, technically known as a "wheal." 
The blotches resemble closely in appearance those produced on the skin 
by contact with the common stinging nettle. Occasionally the white 
patch in the centre is absent, but usually, on careful inspection, a small 
area of somewhat paler color can be detected in the centre of the red 
blotch. The blotches seldom occur singly, more generally being 
associated in clusters ; and individually may vary in size from a shilling 
to a five-shilling piece or more. Their outline is generally irregular, 
the edges being indented, and frequently a narrow prolongation of the 
central wheal runs along the centre of each indentation. When the 
eruption appears on the face, the eyelids may be so much swollen as to 
almost close the eyes, the nose and lips appear enlarged, and the face 
generally has the aspect of being affected with erysipelas. Sometimes 
the tongue and interior of the mouth are also attacked with the affec- 
tion, becoming swollen and discolored. The change in appearance of 
the skin is accompanied by a sensation of tingling and itching of a 
very intolerable character, which gives rise to much restlessness, and 
to efforts to seek relief by scratching. The most marked feature of 
the malady is the suddenness with which it may disappear from one 
part of the body, without leaving any trace behind, and reappear in 
another part immediately in an equally acute form ; or depart al- 
together, leaving the skin in an apparently absolutely healthy condition. 
The characteristic feature of nettle-rash are so peculiar that it can 
scarcely be mistaken for any other disease, except in the rather un- 
usual instances where the eruption is so general over the whole body 
that the blotches merge in each other, and no distinct wheals appear 
in the centre of individual blotches. In such cases the disease at first 
sight presents superficially the appearance of scarlet fever ; but the 
extreme suddenness of the onset, the absence of fever, and the presence 
of distinct tingling and itching usually make the character of the dis- 
ease apparent. In general, also, a careful inspection will bring to light 
some part of the body w T here the eruption shows a limit, characterized 



246 ECZEMA. • 

by an irregular outline and perhaps by a slight wheal, indicating with 
absolute certainty the nature of the affection. 

The Treatment of Nettle=rash is very simple. If the article of 
diet to which its appearance may be attributed has been very recently 
ingested, an emetic of one or two teaspoon fuls of ipecacuanha wine, 
or better, of a teaspoonful of mustard in half a tumbler of warm 
water, should be given, followed as soon as convenient with a dose of 
castor-oil. If one or two hours have elapsed since the ingestion of the 
food, the castor-oil should be administered without a previous emetic. 
When the eruption tends to recur after the bowels have been well acted 
on, abstinence from meat diet for a day or two, with two or three doses 
daily of fluid magnesia or effervescing citrate of magnesia, will in a 
few days generally effect a complete cure. 

(d) Eczema, in a slight form, is a frequent malady of children, 
and is probably generally the result of a tendency inherited from the 
parents or more remote ancestors, and developed by the irritation of 
dentition, by inappropriate diet, or by residence on an unsuitable soil, 
or in a climate favorable to its manifestation. Children predisposed 
to eczema will often exhibit it during the cutting of almost every in- 
dividual tooth ; and after dentition is completed, the eruption may 
recur at any time that the health is slightly depressed, or the digestive 
organs in any way irritated. The most usual sites for the appearance 
of slight eczema are the flexures of the knees and elbows ; more rarely 
the folds of the groins, and the scalp of the head. In addition to 
these parts, it may present itself in patches on any other situation of 
the body. When first affected with slight eczema the skin appears 
somewhat reddened, and a little more dry than usual, with a slight 
tendency to throw off small glistening scales. This appearance is 
accompanied by some itching, which is apt to be especially trouble- 
some during the night, frequently inducing the child to scratch to such 
an extent as to produce slight bleeding. The patches have usually 
very little tendency to extend in size. The brightness of their color 
varies much from day to day, the irritation which they produce vary- 
ing to some extent with the vividness of their tint. As the acuteness 
of the eczema increases, the skin breaks in small cracks, from which a 
little fluid exudes, giving the surface a somewhat moist appearance ; 
and with the increase of the moisture the small scales disappear, and 
the whole surface assumes a raw and superficially ulcerated aspect. 
The variations in appearance from day to day are usually noticeable. 

Sometimes eczema occurs in a much milder form, producing hardly 
any discoloration of the skin, and presenting itself simply as a some- 
what dry and roughened patch on the skin, with a little exfoliation of 
very small, dry, glistening scales, never becoming so acute as to assume 
a reddened color, or to give rise to itching or irritation. 



COMMON MALADIES OF CHILDREN. 



247 



As a rule, there is do difficulty in diagnosing the nature of the 
malady. Its favorite sites, in the angles of the joints and on the scalp, 
the reddened and scaly or moist appearance, the frequent variation of 
intensity, and the irritation markedly increased during the night, are 
quite characteristic of eczema. The duration of the disease is indefinite. 
It may last days, or weeks, or months, or years, sometimes giving rise 
to much annoyance, at other times subsiding to such an extent as to 
excite not the least discomfort. Its treatment often calls for consider- 
able care, patience, and judgment ; and when the disease persists, re- 
course should always be had to medical advice, as, although no risk to 
life is involved, the irritation and disturbance arising from its presence 
may very seriously affect the general health of the sufferer. 

Treatment of Eczema. — On its first appearance attention should 
be paid to the condition of the digestion. The diet should be made as 
simple as possible, any excess of meat being avoided, and sugar being 
given as sparingly as possible. If the action of the bowels is sluggish, 
it should be promoted by some mild aperient given every second night, 
the most eligible being compound licorice powder. If the eczema is 
associated with irritation from teething, aperients are specially called 
for, and may be given when necessary every night for three or four 
nights in succession. To subdue the heat and itching some soothing oint- 
ment, spread on lint or linen, should be applied to the patches throughout 
the night ; and, so far as possible, the child should be prevented from 
scratching. A very convenient ointment for allaying irritation is 
formed by the mixture in equal parts of zinc ointment and Carron oil. 
[The Magnetic Ointment is often useful in such cases. Try it.] 

6. Infectious Eruptive Fevers. — The second class of eruptions 
referred to above includes those associated with and Characteristic of 
some infectious fevers. Infectious eruptive fevers are characterized by 
certain peculiar features, which are common to them all, and which 
serve to distinguish them from other forms of disease. The first and 
most important of these is their communicability from one person to 
another, a property indicated in the title of "infectious" applied to 
them. The infective material which is the vehicle of conveyance has 
been shown within recent years to consist of germs of minute micro- 
scopic size, possessing to some extent individual life, and capable of 
being cultivated and studied in various media, such as gelatine or beef 
jelly, outside and apart from the human body. Usually those infection- 
bearing germs are transferred from the person suffering from the in- 
fectious fever to others by actual contact or by close approximation, 
but they may be conveyed for considerable distances in clothes, books, 
foods, and other articles ; and when circumstances are favorable to 
the life of the germs, as when accidentally adhering to clothing laid 
aside in a drawer, without exposure to fresh air, or when enclosed in 



24S ERUPTIVE FEVERS. 

an envelope, they may retain their infectious powers for many months. 
When any infectious germs obtain admission to milk, they multiply 
with great rapidity, contaminating the whole supply of milk to which 
tliev have had access, and rendering it an infection-bearing fluid of 
much activity. Many severe epidemics of scarlet fever, especially, 
have owed their origin to the accidental distribution of milk contami- 
nated with the germs of that disease. To some extent the same thing 
occurs when impure water is exposed to contamination. 

These germs are present in, and are probably thrown off into the 
surrounding atmosphere from the skin and lungs of every person suffer- 
ing from an infectious fever, from the commencement until the ter- 
mination ; but at different periods in different illnesses they seem to 
exist either in greater number or in more virulent form, as infectious 
diseases are found to vary in their infectious powers at different stages 
of their progress. How is it, then, it may be asked, that so many 
persons who come into intimate association with infectious diseases 
escape the infection ? The answer is that probably every person has 
some power of resisting the attacks of infectious germs, this power of 
resistance varying much in different people, and in different states of 
health in the same person. The length of exposure to the attacks of 
the germs is also in some cases a factor in determining the success or 
failure of the attack. It is frequently observed that doctors com- 
paratively seldom acquire infectious illnesses from their patients, their 
visits lasting only a short time, while nurses are specially prone to fall 
victims, unless protected by previous attacks of the same disease. 

The germs of infectious fevers all lose their power rapidly when 
exposed to the open air, and to the rays of the sun. It is very seldom, 
indeed, that infection is conveyed by means of the air alone farther 
than a limited number of feet from the bed of the patient, except, 
perhaps, in the case of small-pox, the germs of which, some think, 
may be carried some hundred yards without losing their infectious 
property. In almost all cases where infection has been carried for 
some distance from a patient, it will be found on careful inquiry that 
some material vehicle has conveyed the poison ; it may be a letter or 
newspaper, a book, a parcel., or an article of dress worn by someone 
who has been in communication with the invalid. 

Infectious germs can also be destroyed with facility by artificial 
means. Exposure for about two hours to dry heat in an oven, or to 
moist heat in the form of steam in a boiler, effects their destruction if 
the temperature exceeds 200° F. ; and boiling also for twenty minute? 
to half an hour is thoroughly effective in destroying them. Various 
disinfectants also, among which carbolic acid, permanganate of potash. 
(Condy's fluid), and chloride of lime are specially worthy of mention, 
are reliable as destructive agents of infectious germs, when employed 



CHICKEN-POX. 



249 



with proper care and in suitable strength. Some directions for their 
employment are given in Chapter XVI. 

It has to be remarked that no satisfactory method has yet been 
discovered of arresting the infectious germs before they leave the 
patient, which, were it possible, would be the most thorough way of 
preventing any extension of infection. Efforts in this direction are 
made by anointing the skin with disinfectant ointments, but though 
the excretion of germs from the skin may be thus prevented, they 
make their escape by the breath, as well as in other excretions ; and it 
is impossible to saturate the air with any disinfectant sufficiently to 
destroy the germs, without at the same time rendering it dangerous of 
respiration to the patient. 

Stages of Infective Fevers. — Another peculiarity of infectious 
eruptive fevers is that all run a definite, and to a considerable extent 
similar course, which is characterized by four distinct stages, easily 
recognizable in each individual disease. The duration of these stages 
varies in the different forms of eruptive fevers, but is fairly constant 
for each special fever. They are known as the stages respectively of 
incubation, of invasion, of eruption, and of desquamation. 

The Stage of Incubation is that period which elapses between the 
reception of infection and the manifestation of any active symptoms of 
illness. Usually for some days after the contraction of infection no dis- 
comfort or sense of illness is experienced, and although sometimes a 
slight sense of malaise and physical depression may be present for a 
day or two before the commencement of the stage of invasion, more 
commonly the beginning of that stage is the first indication of illness. 

The Stage of Invasion occupies the period from the manifestation 
of the first definite symptoms of illness to the commencement of the 
appearance of the eruption. 

The Stage of Eruption extends from the time when the eruption 
first appears to its disappearance, and is followed by — 

The Stage of Desquamation, which usually continues until con- 
valescence is established. 

The approximate duration of these stages in different fevers will 
be mentioned when the individual diseases are described. 

A further peculiarity of these eruptive fevers is that one attack of 
any of them in a great measure protects during the whole of life from 
a second attack of the same disease. The protection is not absolute, 
as every one of them has been known to occur twice or even three 
times in the lifetime of an individual, but such second attacks are so 
unusual that the risk of them may be practically disregarded. 

(a) Chicken=pox (varicella) is the mildest of the eruptive fevers. 
Its period of incubation is long, varying usually from twelve to nine- 
teen days. On the other hand, the stage of invasion is very short, not 



250 COMMON MALADIES OP CHILDREN. 

exceeding twelve to twenty-four hours ; and is often of so exceedingly- 
mild a character that it is overlooked altogether, and the active symp- 
toms appear to commence with the eruptive stage. When any symp- 
toms are noticeable in the stage of invasion, they seldom amount to 
more than slight headache, want of appetite, perhaps a sensation of 
nausea, or even, in young children, some vomiting, and a slight rise of 
temperature seldom exceeding one or two degrees. The eruption ap- 
pears in the form of some small red spots distributed at wide intervals 
over the body and face, which within a few hours change into small 
watery vesicles each surrounded by a faint pink ring. The change 
from spots to vesicles is often so rapid that the vesicles are often con- 
sidered to be the original form of the eruption ; but careful inspection 
will usually show some spots which have not undergone alteration. 
The vesicles are often found to vary in size considerably on different 
parts of the skin, some remaining not larger than a pin's head, others 
increasing in size within twenty-four hours until they measure about a 
quarter of an inch in diameter. They are scattered irregularly over 
the whole body, face, and head, and never occur in isolated clusters, 
like the heat-spots described at the beginning of the chapter. The 
number of vesicles varies greatly, sometimes only a very few, perhaps 
ten or tw T enty, being noticed ; at other times two or three hundred are 
distributed over the skin. Fresh crops are usually thrown out for two 
or three days after the first appearance of the eruption, and some of 
the old vesicles continue their increase in size, never however much 
exceeding a quarter of an inch in diameter. About the third or fourth 
day from the commencement of the eruption it attains its height, and 
the vesicles, varied in size, appear as small globular or ovoid blisters, 
glistening and opalescent, and each surrounded with a faint pink circle 
of skin. After this they lose somewhat their shining appearance, be- 
coming of a dim white or yellow or brownish shade, and dry up 
gradually into dry brown scabs, which usually fall off the skin in from 
ten to twelve days from the first commencement of the eruption. This 
falling off of the scabs constitutes the desquamative stage of the 
disease. Usually on the first falling off of a scab, a very minute 
cicatricial scar can be observed on the skin underneath ; this, however, 
almost invariably disappears after a week or two. Very rarely indeed 
is a permanent little scar, like one of the depressions due to small-pox, 
left behind ; when it happens it is usually due to the child having 
irritated one of the vesicles by scratching. 

The commencement of the eruptive stage of this disease is often 
characterized by considerable itching, which, however, seldom contin- 
ues for more than one or two days, and after this has passed off there 
is very seldom any further complaint of discomfort of any kind. 

Sometimes, especially in girls of from thirteen to sixteen years of 






TREATMENT OF CHICKEN-POX. 



2.^1 



age, the disease takes a more severe form, with considerable fever both 
in the stages of invasion and eruption, accompanied by headache and 
distaste for food. Even in these cases, however, there is never any 
cause for real anxiety. A very exceptional form also occurs in which 
the vesicles, instead of drying into scabs, become changed into un- 
healthy ulcers ; its peculiar character is probably due to residence in 
very unsanitary conditions, and it is met with very rarely indeed. 

Chicken-pox, under ordinary circumstances, involves no risk what- 
ever to the life or to the general health of the child. There is no special 
liability to any complications, nor is the invalid more than usually 
susceptible to cold when suffering from it. The stage at which infec- 
tion is most likely to be given to others is the desquamative stage, 
when the scabs are becoming detached, and may be carried away on 
articles of clothing, or in other ways. 

The Diagnosis of Chicken=pox is not usually difficult. The ap- 
pearance of the vesicles when well developed is very characteristic, the 
white opalescent color, the globular or ovoid shape, the pink areola or 
circle round the vesicles, and the limitation of size to a diameter not 
much exceeding a quarter of an inch, not occurring in any other 
disease. When the vesicles are small and ill developed, there is a risk 
of mistaking them for heat-spots, but their dispersion over the whole 
body and on the face and head, together with the absence of any dis- 
tinct hardness, is usually quite sufficient to indicate their character. 
When very mild, with few and ill-developed vesicles, the disease is 
somewhat apt to be overlooked altogether, the spots being mistaken for 
small pimples of an innocuous character. The presence of chicken- 
pox in such cases may be considered very probable, if a crop of small 
pimples with slight watery heads appear simultaneously over the body 
and on the face. Usually a careful examination in such mild cases 
will show on one or two of the spots vesicles of sufficient development 
to indicate with certainty the nature of the illness. 

No active treatment is required. If feverishness or sickness is 
present, the patient should be kept in bed for one or two days, and 
limited to light food such as milk, milk puddings, and soups ; and the 
action of the bowels should be regulated. Itching is best allayed by 
warm baths, and by inunction of vaseline. 

Caution. — In order to prevent the spread of infection, the invalid 
should be isolated until every scab has dropped off ; and during the 
desquamative stage a warm bath, should be given night and morning. It 
is not necessary to fumigate rooms in which a patient with chicken-pox 
has been confined, but the carpet of the room should be beaten in the 
open air, the floor washed with carbolic acid and water, of a strength 
of one part of carbolic acid to forty of water, and the room exposed to 
a full current of fresh air for a whole day. 



252 COMMON MALADIES OF CHILDREN. 

(b) SmalI=pox (variola). Anything more than a reference to this 
disease would be out of place in this work, as, even when the attack is 
very slight, the stage of invasion, which occurs after an incubative 
period of twelve days, is nearly always characterized by symptoms of 
such acuteness as to necessitate medical attendance. Those take the 
form of severe headache, moderately high temperature, often reaching 
to 104° F., considerable sickness, and markedly defined pain in the 
back. If small-pox is prevalent, the presence of these four symptoms 
is almost certain evidence of the commencement of an attack. The 
stage of invasion usually lasts three days, after which the eruption 
appears in the form of small red pimples rather hard and "shotty " to 
the touch, disseminated over the face and body in varying numbers. 
These pimples may in a day or two develop into small vesicles, or they 
may gradually fade, and recovery at once ensue. The peculiar feature 
of modified small-pox is that, instead of going through the usual 
course of unmodified small-pox, it is usually cut short soon after the 
appearance of the eruption, recovery following immediately, and the 
desquamative stage being so little marked as almost to escape notice. 
In unmodified small-pox the pimples gradually change into vesicles, 
which, at first very small, increase up to the eighth day after the ap- 
pearance of the eruption, until they attain the size of a sixpenny piece 
or a silver dime. On the eighth day the vesicles become inflamed, and 
suppurate, their contents changing into matter ; they then commence 
to dry up or to burst, and form hard scabs, which usually fall off in 
the course of ten days or a fortnight, leaving depressed marks on the 
skin. In the modified form the disease seldom goes beyond the point 
of the formation of small vesicles, which dry quickly and fall off, 
leaving usually no mark behind. 

(c) Scarlet Fever, or Scarlatina, is a disease which varies very 
much in its severity in individual cases, and in different epidemics. 
Sometimes it is so severe, and its course so rapid, that it may cause 
death in twenty-four hours ; at other times so slight as to involve to the 
sufferer only a few days' discomfort. Even in the slightest instances, 
however, there is always some risk of serious complications, and it is 
therefore desirable that all cases of scarlet fever should be placed 
under medical care and supervision. 

The stage of incubation of scarlet fever is usually short, varying 
from twenty-four hours to six days. At the end of this stage the child 
is attacked with headache, sickness, sore throat, sometimes some shiver- 
ing, and occasionally, in young children, convulsive fits ; and usually 
considerable fever is present, the temperature not unfrequently rising 
to 104* F. The stage of invasion lasts for about two days, after which 
the eruption appears. In mild cases the stage of invasion may be 
shortened to one day ; in very severe cases it may be prolonged to three 



SCARLET FEVER. 253 

or even four days. The eruption presents itself usually as a general 
flushing and reddening of the skin of the face and body, which on 
close inspection is seen to be caused by innumerable small scarlet spots, 
each surrounded with a small circle of paler red. The spots, which 
are about the size of a small pin's head, are generally so closely aggre- 
gated that the paler circles round them merge entirely in each other, 
and thus produce the general flushing of the skin. The eruption is 
usually at first most apparent on the neck, behind the ears, on the 
chest and abdomen, and on the front of the arms near the elbows. 
Generally in the course of twenty-four hours it has spread over the 
whole body ; but in some cases the eruption is partial throughout the 
disease, limiting itself perhaps to the body and thighs and arms ; such 
instances, however, are quite exceptional. The sore throat, which is 
nearly always present to some degree during the stage of invasion, 
usually increases in severity in the eruptive stage ; sometimes a spotted 
appearance is noticed on the roof of the mouth, as if it also were 
affected with the eruption. 

The rash usually remains of a vivid scarlet hue for three or four 
days, after which it fades into a more dusky shade, and gradually dis- 
appears. The stage of desquamation follows, sometimes immediately, 
sometimes after the lapse of two or three weeks, and continues usually 
until at least six weeks have elapsed from the commencement of the 
illness. The more acute the eruption has been, the more early, as a 
rule, desquamation commences, and the more marked in character it 
is. Sometimes the external skin comes off in large flakes and shreds ; 
in the case of the fingers it may come off in moulds like the fingers of 
a glove. More commonly it is shed in small scales, with a few larger 
shreds here and there. Desquamation continues longest in the hands 
and feet ; not unfrequently the process in the feet is not completed 
until the expiration of nine or ten weeks from the beginning of the 
fever. Occasionally a slight second desquamation takes place over the 
body after the first is finished. 

The Diagnosis of Scarlet Fever, when the symptoms are well 
marked, is very easy ; when they are not well marked it may be ex- 
ceedingly difficult. In ordinary cases the nature of the disease is in- 
dicated clearly by the somewhat severe premonitory symptoms, the 
inflamed throat, the degree of fever, and the characteristic scarlet 
color and maculated appearance of the rash. Slight cases, where 
there is scarcely any soreness of throat, very little fever, and a some- 
what undefined rash, are apt to be mistaken for rose-rash. The exist- 
ence of any soreness of throat should always be regarded as suspicious. 
When there is any fever with rose-rash, it is generally of short dura- 
tion, subsiding within twelve or twenty-four hours ; in scarlet fever 
the fever tends to increase for the first few days ; frequent observation 



254 



COMMON MALADIES OF CHILDREN. 



with the clinical thermometer is therefore of value in making the dis- 
tinction. The rashes are sometimes very similar. The chief points of 
difference are the more scarlet hue of scarlet fever, its presence 
generally rather marked in the face, which is unusual in roseola, and 
its more general distribution over the whole body and limbs, roseola 
being usually present on a more limited area. A very characteristic 
feature of scarlet fever, when present, is a dry injected appearance of 
the white part of the eyes. The other diseases for which scarlet fever 
n*ay be mistaken are measles and rotheln ; the points of difference will 
be mentioned when these diseases are described. 

Scarlet fever is an exceedingly infectious disease in all its stages, most 
so during the stage of desquamation. The utmost care in isolation 
and disinfection must be exercised to prevent its extension, and even- 
possible channel of communication should be guarded. The necessary 
precautions have already been mentioned in the chapter on Nursing. 
Within recent years many well-managed hospitals for infectious dis- 
eases have been erected in various towns in England ; and where house- 
hold arrangements do not conveniently admit of rigid isolation of the 
patient, the propriety of sending him to one of those institutions should 
be taken into consideration. Parents are not unnaturally inclined to 
think such a course unkind to the child, but it is often dictated by the 
best interests both of themselves and of their other children, while the 
invalid is usually after a day or two more happy than he would be at 
home. At home he must be imprisoned with one person — often a 
nurse previously unknown to him — for at least six weeks, without the 
visit of any friends or playfellows ; in the hospital there are other 
children suffering from the same disease, who can spend with him the 
tedious days of convalescence and desquamation in amusements and 
games. And as the hospitals are usually built specially for such dis- 
eases, the conditions are all such as to place the invalid in the cir- 
cumstances most favorable for complete recovery. 

(d) Measles is the most common of all infectious eruptive dis- 
eases, a distinction which it owes probably to its very infectious charac- 
ter during the stage of incubation. The other eruptive fevers are only 
very slightly infectious during their incubation ; measles, on the other 
hand, in most cases is transmitted at this stage, before any symptoms 
are present rendering it possible to recognize in the transmitter the ex- 
istence of any illness whatever. The incubation stage of measles gen- 
erally lasts about twelve days, sometimes a little less. During the last 
two or three days of this period there may be present a little nasal 
catarrh, with slight weakness of the eyes, and general signs of slight 
cold ; but this is not invariably the case. The stage of invasion is 
characterized by feverishness, not generally at all severe, slight head 
ache, cold in the head, watering of the eyes, intolerance of light, and 



MEASLES. 255 

some nausea and loss of appetite. There is also frequently some dry- 
ness of the throat, rarely amounting to actual soreness, a little hoarse- 
ness of the voice, and a slight dry cough. Very often those symptoms 
of invasion are so slight as not to necessitate confinement to bed ; 
sometimes indeed they are almost entirely absent, so that the patient 
is going out of doors until the eruption appears. The duration of the 
stage of invasion is generally about four days. The eruption usually 
appears first on the face and the neck, in the form of dusky crimson 
spots very slightly elevated, like pimples, each surrounded by a little 
circle of paler red skin. As the spots increase in number, and become 
closely aggregated, the paler circles coalesce, and the whole skin be- 
comes somewhat swollen and flushed, and covered with small prominent 
darker-colored spots. Commencing on the forehead and neck, the erup- 
tion usually spreads in the course of about twenty-four hours down- 
ward over the whole of the body and limbs. The spots frequently 
tend to group themselves in a crescentic form, and when the eruption 
is not close enough to obliterate all the healthy colored skin between 
the spots, a series of small red crescents, varying in size from a quarter 
of an inch to an inch in diameter, may present themselves on the skin, 
each made up of a group of spots with their accompanying pink 
borders. As the eruption is coming out the fever usually increases 
considerably, the temperature rising to 104° F. or 105° F., but it 
generally subsides immediately the rash is fully developed. Coinci- 
dently with the development of the eruption the catarrhal symptoms 
increase, the cold in the head, the discharge from eyes and nose, and 
the cough being often very troublesome. There is often also consider- 
able itching of the skin. 

"Within one or two days after the appearance of the rash, it begins 
to fade somewhat in brightness, the change being first noticed in the 
forehead and neck, where the eruption first appeared, and gradually 
extending to the rest of the body. The prominence of the papules at 
the same time diminishes, and in three or four days all traces of erup- 
tion are gone, with the exception of a somewhat mottled appearance 
of the skin in some parts of the body. As the rash subsides desquama- 
tion occurs usually in a very slight and inconspicuous manner, the skin 
coming off in minute silvery scales. Not unfrequently the desquama- 
tion is so slight as to be almost imperceptible. It is generally com- 
pleted within a week of the disappearance of the eruption. 

The Recognition of Measles is very easy when the symptoms 
are well marked. The catarrhal condition of the eyes and nose, the 
troublesome cough, the feverishness, and the crimson papular eruption, 
are quite sufficient to indicate distinctly the nature of the illness. 
When the attack is mild and ill defined, it may be mistaken for mild 
scarlet fever on the one hand, or for rfttheln or roseola on the other. 



256 COMMON MALADIES OF CHILDREN. 

From scarlet fever it is distinguished by the more papular character of 
its eruption, by the crimson color as contrasted with the scarlet of 
scarlet fever, and by the presence of some amount of coughing, a feat- 
ure rare in scarlet fever. The appearance of the eyes in measles also 
differs much from their aspect in scarlet fever. In measles the eyelids 
are swollen, and the eyes flushed and watery ; in scarlet fever the eye- 
lids are not swollen, and the eyes are dry and injected. From roseola 
measles is distinguished by its comparatively greater severity, and by 
the presence of catarrhal symptoms and cough. Roseola is a very 
mild disease, with little or no fever after the first day, and no catarrhal 
symptoms, except rarely very slightly inflamed throat ; in measles 
there is nearly always some fever present as the eruption develops, as 
well as some catarrhal symptoms in the nose, and some amount of 
coughing. The eruption also in measles is usually more marked, and 
more universally distributed over the body, than in roseola. 

From rotheln it is often exceedingly difficult to distinguish meas- 
les. Points of difference will be mentioned when the former disease 
is described. 

Treatment of Measles. — Mild attacks of measles call for very 
little treatment. The patient must be kept in bed for some days, and 
the room must be maintained at a uniform and moderately high tem- 
perature. The great risk in measles lies in complications affecting the 
lungs. Bronchitis and inflammation of the lungs are the most frequent 
serious complications of measles, and they are best guarded against by 
the temperature in the sick-room never being allowed to fall below 64° F. , 
and raised when necessary to 70° F. "When cough is troublesome, a steam- 
kettle should be kept constantly on the fire ; if there is indication of 
difficulty in breathing, the chest should be enclosed in linseed-meal 
poultices. When the cough is very frequent and hard, much relief is 
often afforded by the administration of five or ten drops of ipecacuanha 
wine in a teaspoonful of glycerine every three hours. When thirst is 
troublesome the patient should be allowed to drink freely barley- 
water flavored with lemon juice ; cold water, in small quantities at a 
time, is also very grateful and innocuous. When the skin is hot and 
irritable much comfort is afforded by frequent sponging with tepid 
water, or vinegar and water. 

Any indication of complications affecting the lungs, such as in- 
creased rapidity of breathing, much wheezing in the chest, or rise of 
temperature, after the full development of the eruption, should always 
be considered as necessitating resort to skilled medical assistance. 

(e) Rotheln, or Epidemic Roseola, as it is sometimes called, is an 
infectious disease which occurs occasionally in epidemics, and which in 
some features resembles slight measles, in some mild scarlet fever. 
Its stage of incubation varies from six to twenty-one days, and is 



ROTHELN: MUMPS. 257 

usually followed almost immediately by the stage of eruption, the 
intermediate stage of invasion seldom lasting more than a day, and 
often being abseift altogether. The eruption usually resembles that of 
measles, but the spots are not generally so closely grouped, remaining 
discrete, with small distinct areas of pink skin round each spot. There 
are at first no distinct catarrhal symptoms of eyes and nose as in 
measles ; but the throat is generally rather sore, red, and dry, as in 
mild scarlet fever. As a rule, there is no cough. A very characteris- 
tic feature, which is nearly always present in some degree, is enlarge- 
ment and tenderness of the glands under the skin at each side of 
the neck. 

Sometimes the eruption resembles closely that of mild scarlet fever, 
and when this is combined with some degree of inflamed throat, it is 
almost impossible at once to make a definite diagnosis. The main 
points of distinction are that the eruption of rotheln usually fades 
within two days, while that of scarlet fever as a rule lasts three or four 
days ; that tenderness of the glands of the neck is unusual in the 
beginning of scarlet fever, while very common in rotheln ; and that 
scarlet fever concludes with distinct desquamation, whereas in rStheln 
no perceptible desquamation occurs. In rare cases all points of dis- 
tinction fail, and the disease must be treated with the care due to 
scarlet fever, although the probability may be in favor of the milder 
disease of rotheln. 

Treatment of Rotheln. — When the diagnosis of rotheln is cer- 
tain, the treatment is very simple. There is practically no risk of any 
dangerous complication, and the disease is always mild. Two or three 
days' rest in bed, with light diet, is generally all that is necessary ; 
and frequently recovery is so rapid that the patient is able in a week 
from the commencement of the illness to go out of doors, and resume 
ordinary habits of life. 

Two infectious diseases are common in children, which are not 
characterized by any eruption of the skin, but which in some other 
respects bear a considerable resemblance to the infectious eruptive 
fevers just described. These are Mumps and ~W"hooping-cough. 

Mumps, or Parotitis, is a febrile infectious disease characterized 
by swelling and tenderness of some glands situated at the side of and 
underneath the lower jaw, and known as salivary glands, on account 
of their function of secreting saliva. Its stages of incubation varies 
from eight to twenty-one days, during the latter part of which there is 
sometimes experienced a feeling of lassitude and malaise, without any 
definite symptoms of illness. The stage of invasion commences with 
sensations of chill, accompanied with rise of temperature, headache, 
and occasionally nausea and vomiting ; and after a few hours, or per- 
haps a day, local symptoms pijesent themselves in the form of slight 



258 COMMON MALADIES OF CHILDREN. 

swelling and tenderness at the side of the face in front of and below 
the ear, or underneath the lower jaw, with stiffness and pain in moving 
the jaw for the purpose of eating or speaking. Sometimes the swell- 
ing at first is present only at the side of the face, sometimes only under 
the jaw, sometimes in both situations at once ; occasionally it affects at 
first only one side of the head, in other cases both simultaneously. 
When it appears at first at the side of the face, it usually in a few days 
afterward affects the region under the jaw on the same side ; conversely, 
when it attacks the glands under the jaw first, it generally invades that 
on the same side of the face afterward. When it attacks at the com- 
mencement only one side of the face, it usually proceeds to the other 
side in a few days ; when both sides of the face are affected at the same 
time, they often differ considerably in the extent of the swelling. For 
the first day or two the swelling is usually inconsiderable, but it gener- 
ally increases gradually for four or five days, until the side of the face 
presents a large and tense swelling, occupying the greater part of the 
cheek from the eye above, to the border of the lower jaw below, and 
bounded behind by the ear, the front part of which is pushed outward 
by the swelling. Underneath the lower jaw the chin is seen to be very 
full and swollen, as if the upper part of the neck had suddenly become 
very fat. The skin over the swollen gland is seldom at all discolored, 
but becomes tense and glistening from being stretched. Not unfre- 
quently there is some deafness and pain in the ears, due to the pressure 
of the swollen glands. 

- After remaining swollen and tense for a few days, the glands be- 
come softer and commence to subside, those which were first attacked 
subsiding first. As the glands diminish in size, the skin covering them 
loses its tenseness, becomes somewhat dry in appearance, and usually 
desquamates in small scales. 

Mumps is a very infectious disease, and may affect persons of all 
ages who are not protected by a previous attack. It is not a malady 
of much gravity, but gives rise to a great deal of discomfort, which 
usually bears some proportion to the age of the patient. Babies and 
young children generally take it very mildly, older children in a 
more marked form, while adults often suffer very severely. Like 
measles, it is markedly infectious during the stage of incubation, as 
well as throughout its whole course. 

Treatment of Mumps. — Active treatment is not as a rule called 
for. The patient should be kept warm, but not necessarily in bed, and 
the diet should be moderately light and nutritious. Attention should 
be paid to the regular action of the bowels. To relieve the stiffness 
and discomfort arising from the swollen glands, gentle friction once or 
twice daily with some anodyne liniment, such as opium liniment [or 
the Magnetic Ointment], may be employed ; or, if mpre grateful to the 



WHOOPING-COUGH. 



259 



invalid, compresses of warm water, or linseed-meal poultices, may be ap- 
plied continuously. Frequent sponging with warm water, followed by 
the application of cotton-wool, often affords much comfort. In all cases, 
however slight, the glands should be protected from exposure to cold 
by being constantly covered with a light silk handkerchief or small 
woollen shawl. 

Whooping-cough, or Pertussis, is an infectious fever of an ex- 
ceptional character. It is not characterized by an eruption, its duration 
is more indefinite than that of the eruptive fevers, and there is no stage 
corresponding to the stage of desquamation in those diseases. Like 
them, however, it has a distinct stage of incubation and of invasion, 
and it resembles them in being infectious throughout its whole course. 

The stage of incubation of whooping-cough occupies from a week 
to a fortnight, during the later days of which a certain amount of 
cough may be present. The stage of invasion then commences with 
slight fever, loss of appetite, and perhaps fretfulness, some amount of 
sneezing, cold in the head and eyes, and occasionally a little dryness of 
the throat. Cough is usually present from the commencement of thi> 
stage, generally most noticeable at night, and most commonly barking 
and croupy, sometimes sharp and ringing in character. It is occasion- 
ally very incessant during the first few nights, interfering much with 
sleep. At this period no characteristic whooping is present. The 
amount of fever is generally very slight, and may only be detected by 
frequent use of the clinical thermometer, which will show a rise of 
temperature to perhaps 101° F. toward evening. This stage may last 
for a week to ten days, after which the disease enters what is known 
as the spasmodic stage, when the catarrhal symptoms diminish, the 
cough appears in more distinct spasmodic fits, and the characteristic 
whoop begins to assert itself. Each fit of coughing consists of a series 
of short, quick coughs, during which the face becomes swollen and 
reddened, followed immediately by a long inspiration, which soon 
assumes the shrill whistling or whooping sound from which the disease 
derives its name. It is seldom that a distinct whoop is heard earlier 
than two weeks from the commencement of the stage of invasion, and 
sometimes it may not occur until the end of the third week. In very 
slight cases no distinct whoop may be heard throughout the whole 
illness. In moderately severe cases three or four or more fits im- 
mediately succeed each other, a whoop intervening between each fit ; 
and the succession may conclude with the expectoration of some whitish 
mucus, or even with sickness, and vomiting of the contents of the 
stomach. Even when no actual vomiting occurs, at the end of an 
attack there is usually some sensation of nausea experienced. 

The spasmodic attacks of coughing occur with varying frequency. 
In mild cases there may be only three or four attacks during the day^ 



2 6o COMMON MALADIES OF CHILDREN. 

time, and one or two throughout the night. In more severe cases the. 
attacks may occur as often as once every hour, during both night aud 
day, and in very bad cases of whooping-cough a much greater fre- 
quency even than this may be encountered. The frequency and the 
length of the fits tend to increase during the first two or three weeks of 
the spasmodic stage, afterward usually diminishing gradually, as con- 
valescence approaches. The transition from the spasmodic stage to 
the convalescent stage is gradual. If the disease has not been compli- 
cated with any serious lung affection, such as severe bronchitis or 
inflammation of the lungs, usually after from four to six weeks from 
the commencement of the stage of invasion the spasmodic attacks will 
become much less frequent, and the cough will be looser in character, 
with fewer fits in each attack, and with diminished whoop. Complete 
recover}', with entire absence of cough, will then result sooner or later 
according to the season of the year and the climatic conditions. If the 
affection has occurred in spring or early summer, the convalescent 
stage may not occupy more than one or two weeks, after which no 
cough will be present ; if, on the other hand, the disease has manifested 
itself in autumn or winter, convalescence may be prolonged through- 
out two or three months, during which some amount of cough remains, 
and an occasional whoop is audible. 

The Diagnosis of Whooping=cough presents difficulty only 
when in its early stages, or when the disease is exceedingly mild. Before 
any whoop is developed, evidence of the nature of the illness/is afford- 
ed by the peculiar sudden and spasmodic character of the cough, by 
its occurrence once or twice or oftener during the night, waking the 
child from sleep, and by the redness of the face, and occasional 
tendency to sickness, immediately following the fit of coughing. 
Suspicion of whooping-ctmgh should always be excited when two, or 
three children associated together, who have never had the disease, 
begin to cough simultaneously ; and this suspicion would be much 
strengthened if any of them exhibited a slight rise of temperature for 
a few days without any apparent cause other than the cough. The 
possibility of having been exposed to infection should also be taken 
into consideration as rendering the diagnosis more probable. 

In very slight cases, where no whoop is present from beginning to 
end, the diagnosis must rest on the spasmodic nature of the cough, on 
its occurrence throughout the night, awaking the child suddenl}', on 
the redness of face and tendency to sickness excited by the cough, 
and, where two or more children are associated together, on ils in- 
fectious character. Every infectious cough which lasts more than a. 
few days is whooping-cough. 

Treatment of Whooping-cough.— Simple cases of whooping- 
cough require very little treatment. Unless the weather is exceedingly 



TREATMENT OF WHOOPING-COUGH. 261 

mild, the invalid should for the first three or four weeks be' confined 
to one room, the temperature of which should be regulated so as lo.be 
as uniform as possible, and not to fall below 60° F. at any period of 
the day or night. If much bronchial catarrh is present, a rather higher 
temperature may be necessary, and the employment of a steam-kettle 
may be desirable. Confinement to bed is not necessary in uncompli- 
cated cases, but the invalid should be clothed warmly, and should not 
be exposed to draughts in any way. The diet should be light and 
easy of digestion, any disorder of the stomach usually aggravating con- 
siderably the severity of the cough. The chest should be rubbed well 
once or twice daily with some stimulating liniment [the Magnetic Oint- 
ment is just the thing needed]. When the cough is troublesome at night, 
its frequency may be diminished by impregnating the atmosphere of the 
room with carbolic acid or creosote. This can be effected either with 
a special vaporizing arrangement, such as is sold by most druggists, or, 
more simply and equally effectively, when a steam-kettle is used, by 
adding a little carbolic acid or creosote to the water placed in it. It is 
found that any disturbance occurring during the night is apt to excite 
a fit of coughing ; care should therefore be taken that the invalid is 
not subjected to any unnecessary noises, or other disturbing influences. 
As convalescence approaches, a little more liberty may be allowed ; 
on fine days the patient may be taken out, and when the weather does 
not admit of this, change to another room during the day is advan- 
tageous. [An infusion of dried red clover blossoms has been found 
very useful in whooping-cough. An ounce and a half of the blossoms 
in a pint of boiling water is allowed to steep for Ihree hours; and a 
wineglassful of this infusion, sweetenecf with honey or sugar, may be 
given every two hours. The vapor from a few drops of oil of turpen- 
tine, dropped on a cloth near the child's nose, makes a good inhaleut.] 

The complications most likely to arise in whooping-cough are 
excessive sickness, and inflammatory affections of the lungs, including 
bronchitis. When bronchitis supervenes, the cough often loses to some 
extent its distinctly spasmodic character, becoming more frequent and 
less whooping. At the same time the breathing becomes quickened, 
and wheezing or gurgling noises are heard within the chest. If in- 
flammation of the tissue of the lungs occurs, the temperature rises, the 
breathing is much quickened, and signs of irritation and fretfulness 
usually present themselves. The presence of either of these complica- 
tions calls for skilled medical advice. 

Occasional complications of whooping-cough are bleeding from 
the nose and convulsions. It is very seldom that the bleeding occurs 
to an extent sufficient to do harm or excite anxiety. When excessive, 
the child should be laid on its back, with the head elevated, and "a 
handkerchief soaked in cold water, or better, a small lump of ice, 



262 COMMON MALADIES OF CHILDREN. 

placed on the forehead, above the nose. The elevation of the hands 
and arms above the head is also of some service in arresting bleeding 
from the nose. 

Convulsions should be treated by placing the child in a warm bath 
of about 98° F. ; and if any disturbance of digestion is suspected, an 
emetic of ipecacuanha wine should be given. 

Responsibility of Parents in Relation to Infectious Diseases. 
— A considerable responsibility rests on parents in relation to the in- 
fectious diseases just described. There is no doubt whatever that their 
prevalence could be much abated, if due precautions were taken, when 
single cases occur, to prevent the spread of infection, and if convales- 
cent patients were always properly isolated until all risk of infection 
from them had passed away. 

In view of the fact that all are infectious to some extent during 
the stage of incubation, it is obviously proper that children who have 
incurred known risk of infection should be isolated from others, until 
the longest period of incubation of the particular disease has expired. 
Thus when a case of measles occurs in a house, every child resident in 
it should be withdrawn from all association with other children, until 
at least fifteen days have elapsed since there has been any contact with 
the invalid. If the original case is not isolated strictly — a course 
which is rarely taken with measles, on account of the extreme prob- 
ability of infection having been disseminated before the character of 
the illness was apparent — no child in the house should be allowed to 
associate with others until fifteen days after complete convalescence of 
the latest patient. The same rule applies to all the other infectious dis- 
eases, allowance being made for the different duration of their periods 
of incubation. 

The prolonged convalescent stage of whooping-cough, and of 
scarlet fever, during the whole of which infection may be conveyed to 
others, calls for great care and consideration. Id whooping-cough it 
is practically impossible usually to confine the patient to one room 
until all risk of infection disappears, as out-door exercise and change 
of air may be uecessary to establish the cure. The one course to 
pursue is to avoid as much as possible contact with other children, and 
to select, as a place of change, some situation where a reasonable 
amount of freedom of movement can be obtained without risk of com- 
municating the disease. In scarlet fever it is best to maintain the 
isolation until all desquamation is completed, with the exception of the 
feet ; if these are then bathed thoroughly with carbolic acid and water 
of the strength of 1 to 20 night and morning, and the stockings worn 
be boiled before being sent to be washed, the convalescent patient may 
mingle with others without risk. In London some convalescent homes 
for scarlet fever patients exist, to which they can be sent at the very 



PARASITIC DISEASES. 263 

commencement of convalescence ; and it is probable that similar 
arrangements will soon be available in other large towns. 

After scarlet fever, all the contents of the room in which the patient 
has been confined should be disinfected by some expert in disinfection ; 
in most districts this duty is now undertaken by the sanitary authori- 
ties. Thorough disinfection of the same character is also required 
after small pox ; but in the case of measles, chicken-pox, rotheln, or 
whooping-cough it is generally considered sufficient to expose the room 
thoroughly to the free ingress of fresh air for one or two days, to air 
well the bedding and bed clothes, to take up the carpet, if any, and 
have it beaten, and to wash the floor with a weak solution, about 1 in 
50, of carbolic acid. 

7. Parasitic Diseases are diseases resulting from the presence of 
some animal or vegetable parasite, which derives its nourishment from 
the person attacked, and grows, and frequently multiplies, at his ex- 
pense. Strictly speaking, the infectious eruptive fevers are parasitic 
diseases, as the bacteria which convey the infection, and which are 
present in the blood as an essential part of the disease, are undoubtedly 
of parasitic character ; but in general the term is restricted to diseases 
in which the parasite is of a more conspicuous and tangible character. 
The disease already described under the name of "thrush" is a typical 
instance. A few other common ones will now be described. 

(a) Ringworm affecting the scalp is a common disease in children, 
due to the development at the roots of the hair of a vegetable parasite, 
named scientifically trycophyton tonsurans. Its presence is usually 
indicated first by the appearance on the head of one or more spots, 
more or less circular in shape, on which the hair appears thinner, or is 
absent altogether, while the skin has lost its smoothness, presenting a 
somewhat rough and pimply surface. The spots may vary in size from 
a threepenny piece to a shilling [half-dime to a twenty -five cent piece] 
or larger ; and tend to spread in every direction, losing to some extent 
their circular shape, and becoming irregular in outline. As the cir- 
cumference of each spot extends, the centre may become smoother and 
more healthy looking, the parasite exhausting the nutrition there, and 
spreading out from the centre in search of healthy hairs. If any spot 
is examined carefully, it will be observed not only that the normal hair 
is much thinner, or is absent altogether, but also that short broken off 
stumps of hair are to be seen scattered over the spot, the remains of 
normal hairs which have been attacked and broken off by the invasion 
of the parasite. These short stumps are the most characteristic sign 
of the disease, and when present to any extent indicate with certainty 
its nature. Any one in the habit of using a microscope can verify the 
presence of the parasite by pulling out one of the short stumps and 
examining it under a moderately strong power. It will be seen not 



264 COMMON MALADIES OF CHILDREN. 

only surrounding the root, "but actually invading the hard tissue of -the 
hair, in the form of innumerable small round spores. 

The disease is of very indefinite duration, if not subjected to active 
and skilled treatment. The spots may increase in size until they 
coalesce, and in time the whole of the scalp may be affected, all the 
hair being lost. This may continue for months or years, after which 
apparently the parasite becomes exhausted, healthy -action of the hair- 
follicles is set up, and the hair again grows normally 

Ringworm of the scalp is very infectious, spreading from one 
child to another with great facility. Adults, however, are very seldom 
•indeed attacked with it, their hair apparently possessing a resisting 
power which the parasite is unable to overcome. 

Successful treatment must be carried out under skilled medical 
advice. Even with the utmost care, it will occupy at least three 
months ; and often six months will elapse before the cure is complete. 
The rapidity of cure is determined much more by the thoroughness 
with which the treatment is applied, than by the selection of the 
individual remedy to be used. Perfunctory application of remedies is 
practically useless ; and mothers will find generally that it is best to 
take the entire management into their own hands, instead of leaving it 
to nurses or attendants ; feeling assured that perseverance, energy, and 
hopefulness in the application of prescribed remedies will ultimately 
result in success. 

During the course of the disease children affected must be isolated 
from others, but confinement to the house is neither necessary nor 
desirable. The constant use of a silk or linen skull-cap during both 
day and night, while the treatment is being carried out, is of much 
value in preventing the dissemination of the fungus which gives rise 
to the malady. 

(b) Itch, or Scabies, is a skin disease resulting from irritation 
caused by a small animal parasite called an acarus. It is alwav.> 
acquired by direct infection, the little animal making its way from the 
skin of one person to that of another, either by direct contact or by 
transmission in articles of clothing. The symptom which usually 
first calls attention to its presence is intense itching, commonly worst 
soon after the child is put to bed. Careful examination of the skin at 
this time will generally reveal the presence of some small elevated pim- 
ples, the heads of which are often torn off by the amount of scratching 
induced, and replaced by small specks of blood. These pimples arc 
usually seen first in the angles between the fingers, but may occur on 
any other part of the skin. As the disease progresses the skin show.* 
general signs of irritation, becoming roughened and- pimply at different 
places, and scarred with traces of severe scratching. The face almost 
invariably escapes attack. The duration of the affection is unlimited. 



THREAD-WORMS. 265 

continuing until proper means of cure have been successfully applied. 

The Diagnosis rests mainly on the sites of the irritation, associ- 
ated with distinct evidence of contagion. If two or more children or 
adults in one household suffer for a little time from severe itching, 
becoming intensified on going to bed, and if signs of irritation are 
visible between the fingers, the probability is very strong that they are 
suffering from scabies. Absolute certainty can only be attained by the 
discovery of one of the acari causing the affection, the search for 
which calls for some patience and medical skill, as it is minute in size, 
and usually concealed under the skin. 

Treatment of Itch. — When the disease is diagnosed the cure is 
easy. The little animal upon which it depends is destroyed by the 
thorough application of sulphur to the skin. For one or two nights 
successively the patient should be given a warm bath, then rubbed 
well all over the skin of the body with sulphur ointment, the face and 
head being omitted, and put to bed clothed in the uuder-garments 
worn during the previous day. In the morning these garments should 
be removed, another warm bath given, and clean underclothing put 
on. After this has been done two nights in succession the cure is 
usually complete, but it is generally safer for a few nights afterward 
to rub some sulphur ointment into those parts of the body most severe- 
ly attacked, so as to ensure complete eradication. 

(c) ThreadUworms, or Ascarides, are small whitish thread-like 
worms, varying in length from about a quarter to half an inch, which 
infest the lower bowel of many children, and often create considerable 
itching around the external opening of the bowel. During the day 
they remain within the bowel, and give rise to little or no discomfort, 
but at night they are apt to make their way outside, causing restless- 
ness and itching. Occasionally they wander so far that they may be 
found on the bed sheets, and it is probable that sometimes when two 
children are sleeping together they migrate from one to the other. 

Suspicion of the presence of thread-worms in young children is 

usually aroused by some indications of irritation of the digestive canal. 

Restlessness at night, talking in sleep, occasional grinding of the teeth, 

twitching of the face, and sometimes convulsions, call attention to the 

presence of some source of irritation, and careful examination of the 

motions of the child for a few days will demonstrate their presence, if 

they exist in any quantity. The thread-worms, when present in the 

motions, are easily recognised by their whitish color and thread-like 

appearance, their length, which varies from one fourth to three-fourths 

. of an inch, and occasionally by their power of movement. Older 

children will complain of itching around the opening of the bowel, a 

situation which is very little liable to suffer from irritation in children 

from any other cause than the presence of thread-worms. 
8a 



266 COMMON MALADIES OF CHILDREN. 

It is somewhat doubtful how the disease, which is very common, is 
usually acquired. The microscopic eggs of the animals must be 
swallowed attached to some food, and it is probable that raw fruit and 
uncleaned raw vegetables are a frequent vehicle of infection. It is a 
matter of no doubt that the affection is frequently intensified by want 
of cleanliness of the hands of the patients. The thread-worms set 
up an irritation round the opening of the bowel, which the child 
attempts to allay by scratching with the nails ; eggs of the thread- 
worm are often adherent lo the skin in that situation, and become 
lodged under the nails, from whence they are conveyed to the mouth 
of the child. 

Thread-worms should never be considered as a necessary evil to be 
put up with in children. They do considerable injury, not only by the 
irritation they give rise to, but also by their secondary effects, and 
should be combated by skilful medical treatment. Their transmissi- 
bility by unclean hands and nails, referred to above, should impress 
upon mothers and nurses the absolute necessity of aiding medical treat- 
ment by strict attention to cleanliness. 

8, Diathetic or Constitutional Diseases are diseases resulting 
from some constitutional taint or predisposition, which may be either 
inherited, or developed by various insanitary conditions of life, and 
which is frequently due to a combination of these causes. In children 
the most common of these diseases are rheumatism, scrofula, and 
rickets. 

( (a) Rheumatism as it occurs in children is met with in three 
forms, — acute rheumatic fever, subacute rheumatism affecting one or 
more joints, and rheumatism of the muscles. Perhaps the most 
common of the three, and certainly the most insidious, as its apparent 
s lightness not unfrequently induces neglect, with serious ulterior con- 
sequences, is subacute rheumatism in a mild form, affecting at most 
two or three joints. Both this form and acute rheumatic fever are 
prone to be complicated with inflammatory affections of the valves of 
the heart, resulting in time in chronic heart disease ; and this complica- 
tion occurs almost as frequently in slight attacks as in severe ones. It is 
unnecessary to describe acute rheumatic fever, as it is an illness of such 
severity as invariably to demand medical attendance : the description 
given here will be limited to mild attacks of subacute rheumatism of 
the joints, with a few remarks on muscular rheumatism. 

The first and most striking symptom of rheumatism is pain in some 
particular joint or joints, increased by movement of the joint, and 
accompanied usually by some tenderness on pressure. "When a child 
is not old enough to complain verbally, it will be noticed that there 
is reluctance to move one or other of the limbs, a tendency to hold the 
limb in a stiff position, and a disposition to cry upon movement. If 



RHEUMATISM. 267 

the various joints be pressed by the hand, or moved gently, the child 
will show symptoms of discomfort and pain. Generally associated 
with pain, almost from the commencement of the illness, is some degree 
of swelling of the joint affected. The swelling is frequently not well 
marked, but is usually easily detected if comparison be made with the 
similar joint on the opposite side of the body. Sometimes it is con- 
siderable, and causes tension of the skin with a puffy semitranslucent 
aspect. It is seldom that the skin is at all discolored. Some slight 
amount of fever may or may not be present ; there is usually observ- 
able some impairment of digestion, and slight lassitude and disinclina- 
tion for play. The pain and swelling may continue for a few days, 
and then disappear altogether, leaving the child apparently well ; or 
they may appear in another joint, somewhat prolonging the illness. 

Subacute rheumatism is seldom a disease of much severity or long 
duration, and its importance arises mainly from the possibility of its 
being complicated with some inflammation of the valves of the heart, 
which gives rise to no immediate symptoms, but may make itself ap- 
parent either soon afterward, when the rheumatism has disappeared, 
or in later years of life. This form of heart affection may result from 
the very mildest attack of rheumatism of the joints ; occasionally, 
indeed, it occurs when the joints are apparently quite unaffected ; a 
slight degree of fever, and, perhaps, some little stiffness, alone being 
present to indicate the rheumatic nature of the illness. It is in order, 
as far as possible, to prevent the occurrence of heart complications, 
that early recognition and early treatment of the very mildest rheuma- 
tic attacks are so important. The recognition must be based on the 
coexistence of pain and slight swelling, in the absence of any injury 
likely to have caused them. It is when only one joint is affected that 
the difficulty of diagnosis mainly presents itself. Children in their 
play are apt to strain joints slightly, and may complain of pain or 
stiffness for a few days afterward. The distinction lies chiefly in the 
character of the swelling. When a joint has been injured by accident 
there will not unfrequently be seen some discoloration from bruising, 
and when no signs of bruise are present, the swelling is soft, and of a 
fluid character to touch ; when affected with rheumatism no bruising- 
is noticeable, any slight discoloration present is of pinkish hue, and the 
swelling tends to be rather puffy and doughy when handled. In 
rheumatism the tenderness to touch, and pain on movement, of the 
joint are usually greater than in inflammation of a joint from accident. 
When two or more joints are affected, there is little room for doubt, as 
it is very rarely that more than one joint is injured by accident at one 
time. Complaints of pain in the limbs from children should always 
excite suspicion of rheumatism. Children are not prone to make com- 
plaint of pain unless there is reason for it, and attention should always 



268 COMMON MALADIES OF CHILDREN. 

be- directed to discovering, if possible, the source of the discomfort. 

The proper treatment, when any symptoms of rheumatism affect- 
ing the joints are observed, is to confine the child to bed, clothed in 
flannel, and placed between blankets without any sheets, to restrict it 
to milk food, and to place it under medical supervision as early as 
possible. 

Children occasionally suffer from rheumatism affecting the muscles 
In this form there is no tendency to complications affecting the heart 
and as the pain is seldom acute, the malady is one of very minor im 
portance. Muscular rheumatism may occur in any part of the body 
the muscles of the back and shoulders are perhaps the most frequently 
affected. The symptoms are pain, usually increased by some particular 
movements, some degree of stiffness, and occasionally a little tender 
ness on pressure. When these three symptoms are found in a child 
otherwise well, and nothing further is noticeable to which they might 
be referred, the probability is that they are the result of muscular 
rheumatism. The duration of this form of rheumatism is short, seldom 
exceeding one or two days. It is generally the result of some exposure 
to draught on a limited part of the body, and seldom calls for any 
treatment beyond the maintenance of warmth, and the soothing of pain 
by the application of a mild mustard and linseed-meal poultice, or by 
friction with some anodyne liniment. [The Magnetic Ointment is ser- 
viceable for this, and the Anti-rheumatic Tablets, Xo. 8. See page 1228.] 

(b) Scrofula is a constitutional taint which manifests itself most 
conspicuously by a tendency to chronic enlargement of glands, pro- 
ceeding from a low form of inflammatory action, and often resulting 
in the formation of matter. The glands specially affected by this 
malady are known as lymphatic glands, and are distributed all over 
the body, being specially numerous in the neck, the armpit, the groin, 
and one or two other situations. Normally they are so small and soft 
as to be undetectable by sight or touch, even when situated immediate- 
ly under the skin ; when somewhat enlarged, they are recognizable 
to touch as small rounded or oval beads, somewhat separated from 
each other, and occurring usually in chains ; as they increase further 
in size, they become apparent as prominent swellings, varying in size 
from a pea or bean to a billiard-ball, smooth in outline, more or less 
movable under the skin, and painless to touch unless acutely inflamed. 

Lymphatic glands never become enlarged unless some source of 
irritation exists on the surface of the skin, or mucous membrane, or other 
tissue with which they are immediately connected. In the case of the 
lymphatic glands of the neck, the source of initation may be found 
in some affection of the scalp or of the hair, in some disease of the ear, 
of the throat, or of the nose, or in some inflammatory disturbance con- 
nected with the teeth. In those of the armpits and groins, the initia- 



SCROFULA. 269 

tory irritation is usually discernible in some injury or inflammatory 
affection of the hands or arms, or of the feet or legs. Even in perfectly 
healthy children, sources of irritation such as have been mentioned 
will occasionally excite some enlargement, and a little tenderness of 
the associated glands. The striking peculiarity of scrofulous children 
is, that in them the lymphatic glands become enlarged with very much 
slighter provocation than in healthy children, and when enlarged, do 
not subside and become reduced when the source of irritation is re- 
moved, as happens usually when no scrofulous taint exists. Such per- 
sistently enlarged glands are known as scrofulous glands. 

In many instances the exciting cause of the enlargement is so slight 
and temporary, that all trace of it may have disappeared before the en- 
largement of the glands becomes manifest ; it should, however, always 
be searched for, as its early discovery and treatment may modify very 
much the extent and degree of the enlargement. Not unfrequently 
the source will be found in some slight chronic inflammation of the 
skin, or some irritable condition of the mucous membrane lining the 
nose, mouth, or throat. Among the more common of these are eczema 
of the scalp and behind the ear, inflammation of the external passage 
of the ear, with discharge, chronic inflammation of the eyelids, gum- 
boils, and enlargement of the tonsils. These are all very frequently 
found originating scrofulous enlargement of the glands on either side 
of the neck. 

Scrofulous glands, after their initial enlargement, often remain 
constant in size and absolutely painless for many months or years. 
They are, however, exceedingly liable, as the result of some fresh 
irritation, or of exposure to cold, or of depressed health, or even of 
direct injur3 r , to take on acute inflammatory action, and develop into 
abscess. When this occurs, the gland becomes increased somewhat 
in size, tender to touch, less movable under the skin, and more doughy in 
character ; some amount of throbbing and sense of heat are usually 
experienced in it, while the skin over it becomes gradually of a dusky 
red color. In a little time matter forms, and if not allowed to escape 
by incision of the skin over it, it breaks through, by making one or 
more small ragged openings for itself, and continues to ooze out 
through these openings for an indefinite time, fresh matter being 
always formed by the unhealthy remnants of the gland underneath 
the skin. 

When the enlarged gland is not excited to further inflammation and 
formation of matter by any of the causes mentioned, and when the 
general health improves, partial absorption may occur, the gland be- 
coming smaller and harder, and in time sometimes almost entirely 
disappearing. 

Scrofulous children are always more delicate than others, not only 



270 COMMON MALADIES OF CHILDREN. 

in their tendency to enlargement of glands, but also in their proneness 
to inflammatory attacks of various kinds. They are especially liable 
to bronchitis, to enlargement of the tonsils, to disturbances of the 
digestive system, and to some affections of the skin and bones ; and are 
very susceptible to injury from exposure to cold. The disease also 
tends to the development of consumption in later life. 

Scrofula owes its origin largely to hereditary taint, but it is also 
frequently developed, and still more frequently aggravated, by residence 
in insanitary conditions. Dampness of soil, inefficient drainage, impure 
water-supply, and want of sunshine are fertile promoters of the disease ; 
and improper diet also assists in its development. It is much more 
common in low-lying inland towns than among the uplands or at 
the sea-side. 

Treatment of Scrofula.— The general treatment of scrofula re- 
solves itself into the removal of all sources of irritation likely to excite 
the sensitive lymphatic glands, and the maintenance of the highest 
attainable standard of health. All inflammatory affections, such as 
have been mentioned above as originating enlargement of glands, 
should be referred to medical care as soon as they appear, and treat- 
ment should be persevered in until complete cure results. At the same 
time, great care should be directed to the general health of the child ; 
warm clothing, regular exercise, nourishing diet, and, as far as pos- 
sible, an open-air life are of essential importance. Change of air 
occasionally is also of much value ; children having their home inland 
should be sent preferably to the sea-coast, while those whose usual 
residence is near the sea should be transferred to elevated inland 
resorts. Independently of change, it is undoubted that residence in 
bracing sea-side places, such as towns on the east coast of England and 
Scotland, is very beneficial for scrofulous children, a fact which should 
be taken into consideration when any question arises of sending chil- 
dren affected with this disease to schools away from home. 

Treatment by medicine occupies a very inferior position to the 
hygienic measures described ; the undoubted value of cod-liver oil 
in scrofula is probably quite as much due to its quality as an easily 
digested fatty food, as to any specific medical virtue it may possess. 
[Botanical blood-purifying treatment can be very effectively employed 
in such cases, and should be before incurable damage from scrofulous 
inflammations has had a chance to impair the child for life. See 
page 1226.] The management of glands inflamed and threatening to 
form matter must be intrusted to a medical man. As the glands are 
often situated rather conspicuously, it is of much importance that the 
scar resulting from formation of matter should be as small and as little 
visible as possible ; and much can be done to effect this by careful 
treatment, and by surgical interference at the proper moment. 






RICKETS. 



271 



(c) Rickets is a disease affecting the general health, and more 
especially the bony development, of children, which results chiefly 
from improper diet and unhealthy conditions of life, but is also some- 
times apparently traceable to hereditary influences. Its most common 
cause undoubtedly is defective nutrition from insufficient or indigesti- 
ble food in early life, and the disease is accordingly much more com- 
mon in children artificially fed, than in those nursed by their mothers 
or by wet nurses. Residence in houses badly ventilated or imperfectly 
drained, or deprived of a due amount of sunshine, also conduces much 
to the development of rickets ; and consequently it is encountered 
much more frequently in the poorer districts of over-crowded towns, 
than among the peasantry in country villages. 

Rickets may commence at any time during the earlier years of life 
Most commonly it makes its appearance during the period of the first 
dentition, between the ages of six mouths and two years. 

The first symptom observed is usually a tendency to perspiration 
on going to sleep, affecting generally the whole of the head, face, and 
neck. This symptom is often so striking, that within a few minutes 
after the child goes to sleep the head will be seen to be covered with 
drops of perspiration, which continue during the whole period of 
sleep. Coincidently with this there is usually some restlessness during 
sleep, which causes the child to throw off the bed-clothes even in cold 
weather, and a tendency to roll the head on the pillow in such a way 
as to result sometimes in thinning of the hair on the back of the head. 
At the same time is often observable some enlargement of the ends of 
the bones of the arms and legs, the wrist-joints, the ankle-joints, and 
the knees especially appearing larger than in healthy children. Some 
enlargement of the head also is usually present, and a very noticeable 
feature is enlargement of the fontanel les on the top of the head, and 
arrest of their closure. In describing the fontanelles in Chapter XI. 
it was remarked that by the end of ihe first 3 r ear of life they have 
usually diminished very much, and have disappeared altogether before 
two years of healthy life have expired ; in rickety children, on the 
other hand, at the end of one year they may be found larger than at 
birth, and may be widely open even after two years. Associated with 
this arrest of closure of the fontanelles, late development of the teeth 
is frequently observed ; children suffering from rickets may not com- 
mence teething until more than a year old, and may not complete their 
first dentition until after three years from birth. 

Accompanying or following closely on those symptoms comes the 
particular feature which specially characterizes the disease — the soften- 
ing affects to some extent all the bones of the body ; in children able 
to walk, those of the leg are usually the most distorted, as they suffer 
more than others from pressure, In such cases the legs are bent and 



272 COMMON MALADIES OF CHILDREN. 

twisted, assuming most usually a curve outward, but sometimes being 
inclined forward and inward. The bones of the head also alter in 
shape, the skull becoming elongated and usually somewhat flattened 
on the top, while the forehead becomes square, prominent, and some- 
times almost overhanging. At the same time, the face seems some 
what smaller than normal, the development of the bones entering into 
its formation being arrested. 

The bones forming the spine become somewhat softened, and as the 
muscles supporting them are weakened by the disease, the child is 
observed to be "weak in the back," does not sit up like other children 
of its age, and tends to lie down, or to loll in its chair. Softening of 
the bones of the chest gives rise to hollowness on either side of the 
breast-bone, which projects forward, and produces the appearance 
which is known when very marked as "pigeon-breast." 

Rickety children are particularly susceptible to injury from ex- 
posure to cold. From the slightest chill they contract severe attacks 
Of bronchitis, pneumonia, and intestinal catarrh, and recover from 
them much more slowly and with greater difficulty than healthy chil- 
dren, They are also very prone to disorders of the nervous system, 
more especially to spasmodic croup, and to convulsive fits. 

The Diagnosis of Rickets is usually very easy, even in its early 
stage, before almost any deformity of bones is present. The perspira- 
tions during sleep are very characteristic, and, in young children, the 
lateness of teething and the large open fontanelles furnish symptoms 
of much value. These, in conjunction with enlargement of the wrists 
and a tendency to throw off the bed-clothes at night, are quite sufficient 
to establish the presence of the disease. In older children the char- 
acteristic alteration in the shape of the head, together with the pers- 
piration at night, and the enlargement of the ends of the bones, will 
usually suggest the existence of rickets ; and the diagnosis will be 
confirmed when any signs of bending of the bones appear. 

Treatment of Rickets. — Treatment must be directed in the first 
place to the alteration of the conditions from which, in any individual 
case, the disease may be presumed to have arisen. Due consideration 
must be given to the diet, and the possibility of deficiency or of excess 
in any of the ordinary constituents of food must be kept in view. 
Artificial diets of children are often much wanting in cream and other 
fatty substances, the cow's milk which usually enters into them not 
containing normally so much cream as human milk, and being often 
still further wanting in it from abstraction before the milk is sold. 
Excess of farinaceous food is also a frequent error of diet, giving rise 
to some degree of gastric and intestinal catarrh, with a tendency to 
flatulence and diarrhoea. Both these errors not unfrequently conduce 
to the development of rickets. Prolonged suckling on the part of the 



TREATMENT OF RICKETS. 273 

mother sometimes induces rickets in the baby nursed, as the milk in 
time becomes watery and wanting in nourishment, although apparently 
satisfying the appetite of the child. 

Deficiency of animal food in older children tends to the develop- 
ment of rickets, especially when associated with unhealthy surround- 
ings. 

Keeping, then, these facts in view, the food given should be as 
nutritious as possible, and should comprise as much animal food, in- 
cluding fats, as is suitable to the age of the child. Children from six 
months to a year old may be given cream, animal broths, and eggs, in 
addition to milk and farinaceous food ; while the diet of older ones 
may be supplemented with fried fat bacon, white fish, and minced 
meat. The sanitary condition of the home should also be inquired 
into, with special reference to unhealthy arrangement of drains, and 
impurities in the water-supply. The ventilating arrangements of the 
rooms occupied by children also require attention. It must be kept in 
view that children generally spend about half of their life in bed, and 
it is quite as important that they should breathe fresh air during the 
night as during the day. The due admission of air to bed-rooms is not 
unfrequently overlooked, and sometimes indeed is intentionally pre- 
vented with the object of maintaining the temperature of the room. 
Such a condition predisposes strongly to the development of rickets, 
and calls for careful attention. In Chapter XVI. will be found some 
suggestions as to the best method for securing the admission of fresh 
air in proper quantity. 

When all possible sources of injury have been considered and reme- 
died, various hygienic measures are of value in effecting arrest and 
cure of the disease. Chief among these is the daily use of the cold or 
tepid bath, the temperature of the water being reduced as low as can 
be done consistently with obtaining a healthy reactionary glow, and 
with not alarming or irritating the child. When children dislike a 
cold or tepid bath, or tend to feel cold and to shiver after it, the cold 
douche following a warm bath is often advantageously substituted. 

Warm clothing is also of much importance in the treatment of 
rickets. The arms and legs, as well as the whole body, should be 
clothed in merino or flannel both day and night, and warm external 
garments proper to the season should be put on when open-air exercise 
is taken. 

The child should be taken out of doors as much as possible, and 
when in-doors a room exposed to sunshine should be selected for its 
use, when available. 

One of the difficulties in the management of rickets is in prevent- 
ing walking, when the child has arrived at an age at which it can use 
its legs. If it is allowed to walk much, the legs are almost certain to 



274 COMMON MALADIES OF CHILDREN. 

become bent, while, if not permitted to walk at all, it loses much of 
the open-air exercise so essential to recovery. In slight cases usually 
the child may be allowed to walk for a little time during the day, and 
taken out in a perambulator at other times ; in severe cases walking 
must be prohibited altogether, a prohibition most easily enforced by 
encasing the legs in light, well-padded splints which project one or two 
inches below the soles of the feet. When slight bending of the legs 
exists, not sufficient to necessitate the constant wearing of splints, 
their use during the night will often restore the symmetry of the 
limbs, and will not be found to disturb the slumbers of the child. 

Medicinal treatment is of subsidiary importance ; the one really 
valuable drug, independently of those used to meet temporary com- 
plicating conditions, is cod-liver oil, which should be given in doses 
as large as the child is able to digest. 

The rectification of malformation resulting from rickets belongs 
to the domains of surgery, and is a department in which great ad- 
vances have been made in recent years. By surgical means, in the 
present day. some of the most striking deformities of the legs resulting 
from this disease can be almost entirely rectified. 

[The inventive genius of American surgeons has originated the 
remarkable advances in what is called Orthopedic Surgery, by which 
many deformities brought about by scrofula and rickets are more or 
less remedied ; but in another line of treatment a few American physi- 
cians have developed even more important resources for the eradica- 
tion of those blood disorders which deform the body and its members, 
and lay the foundation for destructive disease of its vital organs. In 
no domain of medical practice is the " stitch-in-time " policy more im- 
portant, by which we prevent those distortions without that only skil 
ful surgery can partly mitigate, and the ravages within which lead to 
fatal chronic wasting diseases. See page 1226.] 



CHAPTER XX. 

Management of Some Emergencies. 

Bruises; Sprains; Burns and Scalds; Incised Wounds; Arrest of Bleeding; 
Lacerated Wounds; Foreign Bodies in Eye; Foreign Bodies in Ear and 
Nose; Bleeding from Nose; Emergency Basket; Contents. 

Bruises. — Children in their play are apt to receive accidental in- 
juries, which most commonly take the form of bruises. A bruise is a dis- 
colored swelling resulting from a knock or blow. Both the swelling 
and discoloration arise from the rupture of some minute blood-vessels 
underneath the skin, and the consequent escape of blood, which diffuses 
itself to some distance under the skin around the site of the injury. At 
first as a rule of a deep purple color, as recovery progresses the bruise 
usually becomes successively blue, bluish-green, green, and yellow, 
afterward returning to the normal color of the skin. Different parts 
of the bruise may recover with varying rapidity, so that two or three 
shades of color may be present at the same time on different parts of 
the surface. 

Uncomplicated bruises are seldom of serious importance, the only 
inconveniences resulting from them being the pain and stiffness by 
which they are usually characterized, and the unsightliness of their ap- 
pearance, when on any conspicuous part of the body. 

The best treatment for a bruise is the application of [the Magnetic 
Ointment] or of cold in some form as soon after the injury as possible. 
A handkerchief or piece of lint dipped in cold water, or in weak spirit 
and water, may be employed for the purpose, or when available some 
ice may be used, enclosed in a gutta-percha bag. The cold applications 
should be continued as long as any tenderness to touch is present, after 
which their use may be abandoned. Very little more need be done, 
as the bruise, after the tenderness has disappeared, will gradually 
diminish and fade ; the process of absorption of the effused blood may, 
however, be expedited somewhat by the inunction of some olive-oil [or 
the Magnetic Ointment] once or twice daily. The propriety of rest 
should be decided by the amount of pain consequent on movement. 

Sprains are caused by undue stretching or twisting of joints, the 
ligaments of which are usually partially torn by the strain. There is 
generally also some stretching of other tissues in the neighborhood of 



276 MANAGEMENT OF SOME EMERGENCIES. 

the joint, with rupture of minute vessels and effusion of blood, giving 
rise to the characteristic discoloration of bruising, on the skin over 
the joint. 

There is often considerable difficulty in differentiating severe 
sprains from other injuries of joints, and this difficulty is often greater 
two or three days after the injury than immediately after ; it is there- 
fore desirable that all severe sprains should be seen by a medical man 
as early as possible. Until professional advice can be obtained, the 
joint affected should be kept at perfect rest, and in as elevated a posi- 
tion as possible In sprains of the ankle and knee, the leg should be 
placed on a chair somewhat higher than that on which the patient 
sits ; while in those of the wrist or elbow, the arm should rest on a 
table, or on a pillow if the invalid is laid in bed. Cold applications 
similar to those used for bruises should be employed. Complete rest is 
obtained most easily in the case of the leg by tying it into a pillow, the 
end of which is turned up against the back of a chair, or the foot of a 
bed. The leg is laid along the pillow, the foot being pressed against 
the upturned end, and one or two handkerchiefs or small lengths of 
bandage are tied with moderate tightness round pillow and leg together, 
so as to make the pillow rise on each side of the leg, and encase it as a 
splint. There is usually no difficulty in maintaining the arm at rest 
laid upon a pillow, without any bandages. Slight sprains such as are 
very apt to occur in the ankle joints, when they are weak or have been 
previously strained, are best treated by immediate immersion in water 
as hot as can be comfortably borne. The immersion should be con- 
tinued for ten or fifteen minutes, after which the joint should be 
[rubbed well with Magnetic Ointment] bandaged and used with 
care for a few days. Even slight sprains are prone to be followed by 
some inflammation of the joint injured, and when complete recovery 
does not ensue within a few days medical advice should be sought. 

Burns and Scalds are accidents not unfrequent among children. 
The term "burn" is usually applied to injury received by contact 
with actual flame, or with some solid super-heated body ; while 
"scald" is generally employed to describe the effect produced by 
water or other fluid at high temperature. The injuries resulting from 
burns and scalds respectively are practically similar, differing only in 
this, that burns are usually more limited in area, and deeper in pene- 
tration, than scalds. 

Burns and scalds occur in varying degrees of intensity. In their 
slightest form they appear simply as slightly reddened patches on the 
skin, tender to touch, and associated with sensations of heat. In a 
more severe form the skin is very distinctly reddened and somewhat 
swollen, while the surface here and there is raised in blisters, which 
appear as pale white areas on the red bases. Burns to this extent are 



BURNS: CUTS; WOUNDS. 277 

very painful, the pain being of a severe burning character. A still 
further degree of injury causes entire destruction of the skin, which 
changes into a yellow or blackened sloughing mass. When the slough 
separates an ulcer is left, and this on healing leaves a permanent 
cicatricial mark on the skin. The first two forms described heal with- 
out leaving any permanent trace. 

Burns and scalds are dangerous to life chiefly in proportion to the 
extent of their superficial area. A large slight burn is a much more 
serious matter than a small severe one ; and the amount of pain is not 
any criterion of the degree of danger. In some cases of extensive burn, 
the collapse and shock are so great that hardly any pain is felt for a 
time ; but both the immediate risk and the danger of later complica- 
tions in such cases are very great. Burns and scalds which occupy a 
considerable part of the body very frequently give rise to secondary 
complications, more especially inflammation of the intestines, lungs, 
and kidneys ; their progress should therefore be watched with much 
anxiety. 

The best treatment for slight burns and scalds is the application 
[of the Magnetic Ointment] or some bland oil, such as olive or linseed 
oil, soaked into lint or linen, and covered with oiled silk or gutta-percha 
tissue. When the burnt surface is very tender to touch even when 
dressed in this way, cotton-wool should be placed outside the oiled silk 
or tissue, and the whole gently bandaged. When oil is not immediately 
available, vaseline spread on linen or lint may be used, and when this 
is not at hand, the burn should be thoroughly powdered with flour or 
starch, and encased in cotton-wool or in flannel. The same treatment 
should be employed for severe burns until medical assistance can be 
obtained, and, when the child seems collapsed and weak, a little diluted 
brandy or wine should be given occasionally. 

Incised Wounds. — Cuts inflicted by a sharp instrument are mainly 
important on account of the risk of excessive bleeding ; and the first 
point in the treatment is the arrest of the flow of blood. This is 
generally most easily effected by direct pressure upon the wound with 
a pad of dry lint or linen, kept in position by a bandage. Usually no 
undue amount of pressure is required if the pad is properly adjusted 
exactly over the wound. The pad should vary in size and in thickness 
in proportion to the length and depth of the wound. For a small cut 
on the finger one about half an inch square, and an eighth of an inch 
in thickness, will suffice ; for a severe cut on the hand or arm or leg, 
a pad of two inches square, and of half an inch in thickness, may be 
necessary. The breadth of the bandage should be regulated in accord- 
ance with the part to which it is to be applied. Bandages for the 
fingers should not much exceed half an inch in width, and for the hand 
a width of one inch is sufficient ; for the arm or leg a bandage two 



278 MANAGEMENT OF SOME EMERGENCIES. 

inches broad is usually most convenient, and for any other part of the 
body one of three or four inches in width. 

The bandage should be carefully wound round the part as often as 
is necessary to retain the pad in its place, but should not be employed 
in such a way as to conceal any further bleeding that may take place. 
A very common error in treating wounds is to cover them with so 
many bandages that a great quantity of blood may be lost before it 
appears on the surface of the coverings. It may always be assumed 
that if the pad, pressed well on the cut by a few turns of a bandage, 
is insufficient to arrest the bleeding, no amount of bandaging external to 
it will be successful in doing so ; one bandage alone should therefore 
be used to maintain the pressure of the pad on the wound. 

When pressure in the manner described fails to arrest the bleeding, 
it is usually best to separate well the edges of the cut, and plug it 
thoroughly with small strips of lint or linen, putting on a bandage 
with moderate tightness to maintain the plug in the wound, and to 
exercise some pressure upon the bleeding surface. "When bleeding is 
arrested by the pressure of a pad, the pad should be left undisturbed 
for at least twenty-four hours, after which, if it can be removed easily, 
it may be taken off, and ordinary adhesive plaster put on to protect 
the cut and keep its edges together while it heals. When the pad ad- 
heres closely, and there is difficulty in removing it, it is best to leave 
it in its place, no harm resulting if it is left in position until it becomes 
detached. When plugging has been necessary, the plug should be 
removed gently in from six to twelve hours, the sides of the cut 
brought together and maintained in position by adhesive plaster, and 
the plaster covered by a small pad and bandage. In using adhesive 
plaster to hold in apposition the sides of the cut, long narrow strips 
should be used, as they adhere much better than short broad ones. 

Lacerated Wounds or Tears are generally caused by some blunt 
instrument such as a nail ; sometimes they are the result of heavy fails 
on rough surfaces. They very seldom bleed much, and any flow of 
blood that may exist is generally very easily arrested. As from the 
manner of its production a lacerated wound is often rather dirty, the 
first step to be taken in treating it is to clean it thoroughly. This is 
best done by holding the wound over a basin, and pouring a stream of 
tepid water over it from a height of six to twelve inches, until the sur- 
face is perfectly clean. When clean it should be gently dried by 
pressing against it a soft towel, after which the raw surface should be 
dressed with lint soaked in carbolized oil, of the strength of one part 
of carbolic acid to thirty parts of olive-oil [or Magnetic Ointment.] The 
lint should be covered with oiled silk or gutta-percha tissue, and the 
dressing maintained in position by a few turns of a bandage. The wash- 
ing and dressing of the wound should be repeated once or twice daily. 



FOREIGN BODIES IN EYE, EAR OR NOSE. 279 

Foreign Bodies in the Eye, such as particles of dust or grit, 
create much irritation, with redness and flow of tears, and should 
always he removed as early as possible. In the vast majority of cases 
where a foreign body enters the eye, it becomes adherent to the inner 
surface of the upper eyelid ; and the irritation and pain resulting from 
its presence are due to its being rubbed over the sensitive surface of the 
eye, each time the eyelid is moved in winking. In some few cases the 
irritating particle lies on the inner surface of the lower eyelid ; some- 
times it is to be seen imbedded in the clear part of the eye itself. 

When situated within the lower eyelid there is no difficulty what- 
ever in its removal. The eyelid should be drawn down slightly with 
the finger, when the foreign body will be seen, and can be removed 
easily with the corner of a handkerchief, or with a small camel's-hair 
brush. 

When, as is most commonly the case, the foreign body is adherent 
to the inner surface of the upper eyelid, the most satisfactory method 
of removing it is by everting the eyelid. This eversion, which is often 
performed as a trick by schoolboys, can usually be effected with little 
difficulty, if a child is patient and obedient. The eyelid is first care- 
fully dried, and then gentle pressure is made on it with a blunt point, 
such as the point of a lead pencil, about one-third of an inch above the 
margin of the eyelid, just under the eyebrow. The pressure causes the 
margin of the eyelid to project a little outward from the eye, so that 
it can, along with a few eyelashes, be caught within the finger and 
thumb ; a gentle twist upward then completes the little operation. 
After the foreign body has been removed the eyelid is very easily re- 
placed by turning it downward again. When eversion cannot be 
effected, the foreign body may sometimes be removed by drawing the up- 
per eye-lid well downward over the lower eyelashes, and allowing it to 
recede again two or three times successively, thus making use of the 
lower eyelashes as a brush to sweep the inner surface of the upper eye- 
lid. If the foreign body is seen to be impacted in the clear surface of 
the eye, the child should be taken to a medical man at once, as the 
operation of removal is a delicate one, and much injury may result 
from unskilful interference. 

Foreign Bodies in the Ear and Nose.— Children not unfre 
quently push small objects, such as peas, cherry-stones, and small 
pieces of pencil, into the openings of the ear and nose, and find them- 
selves unable afterward to remove them. Sometimes, perhaps from 
fear of punishment, sometimes from forgetfulness, they make no 
mention of what they have done, and the first indication of the pres- 
ence of the foreign body may be some inflammation of the cavity "in 
which it is situated, with perhaps a little swelling, and usually some 
discharge of matter. When the presence of any foreign body ls'raam- 



2 8o MANAGEMENT OF SOME EMERGENCIES. 

fest. its removal should bo accomplished as soon as possible, but must 
be undertaken with some care, on account of the risk of injuring 
further the already irritated organs. 

When a foreign body is detected in the ear, it should be removed 
by syringing with warm water, and should not be manipulated in any 
way. A strong glass or a brass syringe should be used, and while a 
bow 1 is held under the ear to receive the water returning, the current 
from the syringe should be directed along the roof of the passage of 
the ear. If the foreign body is not very tightly fixed in the ear, it will 
usually be pushed out by the returning current after a few minutes' 
syringing. When it cannot be removed in this way, medical assistance 
should be sought, as much danger may ensue from neglect. 

A foreign body in the nose may sometimes be expelled by causing 
the child to sneeze, either by the use of a little snuff, or by gentle tick- 
ling of the interior of the nostril. If this is not effective, it can fre- 
quently be removed by the aid of a hair pin very slightly altered in 
shape. A hair pin of moderate size is compressed sufficiently to allow 
the curved end to enter the nostril easily. This end is then bent slight- 
ly so as to form a small hook, which should be gently inserted under 
the foreign body, and pushed on until it hooks behind it. If the hair- 
pin is now slowly withdrawn, while at the same time its outer 
end is gradually lowered toward the mouth, the foreign body will 
usually come out lying in the loop. Care must be taken in inserting 
the hairpin that the foreign body is not pushed backward toward 
the throat. 

Bleeding from the Nose is not uncommon in children, but rarely 
occurs to such an extent as to excite anxiety. When it appears very 
occasionally, it may be the result of some temporary disorder of the 
stomach, or of some local irritation of the lining membrane of the nose 
due to cold ; when it recurs frequently it is generally associated with 
some unhealthy condition of the posterior part of the nostrils, or of 
the throat. 

To arrest the bleeding the child should be placed on a chair with 
its head well thrown back, and its arms held above its head, and a 
handkerchief dipped in cold water, or a small piece of ice, should be 
laid on the forehead near the base of the nose. If these means fail 
to stop the hemorrhage, the nostrils may be gently syringed with cold 
or iced water ; this, however, is a somewhat painful remedy, and is 
seldom required. When frequent recurrence indicates the probability 
of some permanent abnormal condition, the child should be placed 
under medical supervision. 

The Mother's Emergency Basket. — In view of the possibility 
of occasional accidents in households, it is very convenient for 
mothers to have a small emergency basket containing articles likely 



EMERGENCY BASKET. 



281 



to be useful on such occurrences, 
should consist of : 

Some lint. 

Some cotton-wool. 

Some old linen. 

A few prepared baudages, vary- 
ing in width from one-half 
inch to three inches. 

A roll of adhesive plaster 

Some safety-pins. 

Ordinary needles and thread. 



The contents of such a basket 

One or two surgical needles, and 

silk thread. 
Some oiled silk, or gutta-percha 

tissue. 
A pair of scissors. 
A nurse's dressing forceps. 
A bottle of carbolized olive-oil of 

the strength of one part of 

carbolic acid to thirty of oil. 



[And a pot of Magnetic Ointment]. 



PART IV. 
LATER MARRIED LIFE. 



CHAPTER XXI. 

The Menopause. 

Change of Life; Age at which it Occurs; Manner of Occurrence; Discomforts 
attending Menopause; Affections of Head; of Digestion; Mental Irrita- 
bility; Depression of Spirits; Physical Alterations; Occasional "Flood- 
ings "; Treatment of Various Symptoms. 

The terms menopause and change of life are usually employed 
synonymously to indicate the period in a woman's life during which 
some marked constitutional alterations take place, of which the most 
striking feature is the cessation of the menstrual period. 

Women in normal health generally menstruate regularly until they 
attain an age varying from forty-two to fifty years, the monthly 
periods only intermitting during gestation and suckling ; then most 
commonly some irregularity in the periods manifests itself for some 
months or even years before complete cessation takes place. Exception- 
ally, the menstrual periods cease at once without any previous ir- 
regularity. 

Generally the irregularity takes the form of arrest of the menstrual 
flow for one or two months, followed by a period somewhat more 
profuse than usual, and again by cessation for several months. Not 
unfrequently the cessation is preceded by several periods of excessive 
menstruation, and, after a few months of arrest, two. or three suc- 
cessive menstrual periods may again appear of exceptional duration 
and amount. In other instances again the menstrual flow becomes pro- 
gressively less at each period, until it ceases altogether. 

Whatever the conditions may be under which the menstrual flow 
ceases permanently, the cessation is as a rule preceded or accompanied 
by various symptoms affecting to some extent both the body and the 
mind. Foremost among these are usually uncomfortable .sensations 

282 



CHANGE OF LIFE. 283 

affecting the head ; frequent headaches, occasional giddiness, and 
paroxysmal flushings of the face being common at this period of life. 
Sudden sensations of heat affecting the whole body are often com- 
plained of, and attacks of palpitation of the heart occasionally occur. 
Neuralgia in various situations not unfrequently presents itself. 
Troubles of digestion are also experienced, more especially flatulence 
and heart-burn. Mental irritability, depression of spirits, and hyper- 
sensitiveness often characterize this period of life, varying in their 
intensity from day to day, and sometimes disappearing for days, only 
to return in a more pronounced form. Some fulness and enlargement 
of the breasts, with sensations of discomfort, tenderness, and even 
pain are often remarked ; and sometimes a feeling of distention of the 
whole body is experienced, with enlargement of the abdomen, partly 
due to flatulence and partly to deposition of fat. 

The cessation of menstruation, together with enlargement and 
pain of the breasts and disturbance of digestion, not unfrequently 
induces the supposition of pregnancy ; and for the first month or two 
after the cessation it is sometimes impossible to be certain that preg- 
nancy does not exist. One factor in the distinction is that the morn- 
ing sickness of pregnancy never presents itself in arrest of menstrua- 
tion due to the access of the change of life. There is no doubt, how- 
ever, that in many cases the differential diagnosis is difficult, if not 
impossible, without a thorough examination of the condition of 
the womb. 

Irregular symptoms connected with the menstrual flow are so 
common at this period of life, that women are occasionally apt to con- 
sider all abnormal conditions presenting themselves as referable to 
the change of life, and thus to endanger their health by the neglect of 
attention to remediable maladies. One of the most common troubles 
thus neglected is occasional severe "flooding" from the womb. Not 
unfrequently this is due not to the age which the patient has attained, 
but to some local disorder of the womb, which may or may not be 
directly associated with the particular period of life reached. If 
allowed to recur frequently without any steps being taken for its arrest, 
a very much weakened state of health may be induced, which may not 
only temporarily render the invalid unfit for her usual duties, but may 
expose her to attacks of dangerods illness. It is very unwise to delay 
obtaining medical advice when abnormal symptoms of this character 
occur. [See page 1226.] 

Treatment of the uncomfortable symptoms accompanying the 
period of the menopause must be mainly directed to regulation of diet 
and mode of life, and promotion of secretions which will to some extent 
serve as substitutes for the arrested menstrual flow. The diet should 
i ,■ light and unstimulating, little meat food being taken, iind that 



284 THE MENOPAUSE. 

mainly consisting of fish or white flesh, in preference to beef or mutton. 
Stimulants should be used in great moderation, if at all ; as a rule total 
abstinence from all alcoholic fluids is best, but in some cases a little light 
wine at meals may be taken. Regularity of exercise in the open air is 
of importance, and warm clothing should always be worn, notwith- 
standing the tendency to sudden flushes of heat. Tepid baths, once or 
twice daily, often give much comfort. 

Medicinally, much relief is often afforded by the systematic em- 
ployment of some saline laxative medicine. Natural waters may be 
taken in moderate doses every morning, or on alternate mornings ; or 
saline medicines, such as effervescing citrate of magnesia or effer- 
vescent laxative salts, may be made use of [and an occasional anti-bil- 
ious pill is often of much service]. 

Healthy occupation for the mind is of much importance at this 
period of life ; its troubles and discomforts are borne much more easily 
when the thoughts are distracted by external duties and pursuits, than 
when allowed to concentrate themselves unduly on the disagreeable 
sensations and other sources of disturbance incidental to the change of 
life. It is, after all, a period of comparatively short duration, and 
when borne with courage and determination emerges eventually into 
the mellow ripeness of elderly life, when the trials and responsibilities 
which have been foreshadowed in the earlier pages of this work are 
regarded in the golden haze of a memory which recalls the pleasures, 
while it forgets the troubles, associated with the past. 

[This is the end of a book full of facts and good advice, but there 
may be readers who will think of something they wish to ask that this 
book does not cover. They should then look through the companion 
volume, written by Dr. Foote (see last pages of advertising) ; and if the 
instruction desired is not to be found therein, then the office of free 
consultation holds good, and Dr. Foote stands ready to write a free 
letter of advice in reply to any well-written inquiry stating plainly just 
what the consultant is looking for. Thus the publishers try to make 
these books entirely satisfactory, and complete any possible deficiencies. 
The doctor's address and offer of consultation may be found on page 
1226.] 



INDEX 



Abdominal belts, 86. 

Abnormal sense of hunger, 22, 23. 

Abortion, 44. 

Abscess of breast, 94. 

treatment of, 95. 

Abscess of ear, 219. 

Accommodation of nurse, 64. 

Additions to milk diet, 150, 351. 

Administration of enemas, 33. 

Afterbirth, description of, 72. 

After-pains, 77. 

Aids to convalescence from confine- 
ment, 84. 

Alcohol, craving for, 13. 

Amount of sleep for children, 308. 

Animal food, solid, 151, 152. 

Antiseptic fluids, 67. 

Aperients after confinement, 78. 

Application of binder after confine- 
ment, 82. 

Applications, external, 180. 

Areola of breast, 24. 

enlargement of, 24. 

— - pigmentation of, 24. 

secondary, 25. 

Artificial food, temperature of. 142. 

means of exercise, 158. 

sources of heat, 175. 

sponges, 66. 

Ascarides, 265. 

Ass's milk, 149. 

Astigmatism, 167. 

B 

Baby's basket, 68. 
Bags, ice, 184. 
Bandages for legs, 40. 
Bapkins, 105. 
Basket, baby's, 68. 

emergency, 280. 

Bassinette, 68. 

Bath, temperature for infant, 120. 

temperature for invalid, 177. 

Bathing during pregnancy, 42, 43. 
Bath? for Infants, 127 



Bed-bath, 65. 
Bed-pan, 65. 
Bed-room, choice of, 63. 

cleaning of, 64„ 

heating of, 64. 

Belts, abdominal, 36. 

after confinement, 67. / 

Bicuspid teeth, 114. 
Binder, 67. 

application after confinement, 82. 

in pregnancy, 43. 

in sleeplessness, 43. 

Bleeding from nose, 280. 

from stump of cord, 121. 

from incised wounds, 277. 

Blood, discharge of, in premature con- 
finement, 58. 
Boots, children's, 131. 
Bottles, feeding, 142. 
Bowel, prolapse of, 238. 
Bowels, cold affecting, 232 

treatment of, 233. 

Bran poultices, 181. 
Bread poultices, 182. 
Breast, abscess of, 94. 

discomfort in, 89, 90. 

discomforts of, 93. 

enlargement of, 24. 

fulness of, 89. 

fulness of, after miscarriage, 54 

inflammation of infant's. 193. 

inflammation of mother's, 94. 

Breast-milk, insufficiency of . 1S9. 
Bronchial catarrh, 214, 
Bronchitis, 214, 231. 

■ treatment of, 216, 234. 

Bruises, 275. 

Burns and scalds, 276. 

Bursting of waters, 72. 



Calisthenics, 158. 

Canine teeth, 110, 114. 

Capacity of infant's stomach, 137. 

Carbolic acid, 67. 

Carbolized vaseline, 67. 



*an 



286 



INDEX. 



Care of breasts during weaning, 99. 

of umbilical cord, 121. 

Catarrh, bronchial, 214. 
Causes of miscarriage, 45. 

of premature confinement, 56. 

of sleeplessness, 43. 

Cautions referring to miscarriage, 54. 
Cessation of menstruation, 19. 
Change of circumstances after mar- 
riage, 15. 

of life, 282. 

Characteristics of cow's milk, 141. 
Chicken-pox, 249. 
Child-bearing period, 12. 
Child-crowing, 217. 

treatment of, 217. 

Chill, symptoms of, 230. 

treatment of, 233. 

Choice of bedroom, 63. 
Chloroform in confinement, 75. 
Cleaning of bedroom, 64. 
Cleanliness of invalid, 177. 

of sick-room, 172. 

Cleanly habits of infant, 128. 
Clinical thermometer, 170, 171. 
Clothing of older children, 129. 

of infants, 122. 

of invalids, 177. 

Club-foot, 163. 

Coal fires, 175. 

Coffee in diet of children, 153. 

Cold affecting bowels, 232. 

affecting stomach, 232. 

applications, 183. 

bathing during pregnancy, 43. 

— — disorders due to, 229. 

during dentition, 213. 

in the head, 230. 

in larynx, 230. 

in throat, 230. 

treatment of, 233. 

Colic during dentition, 213. 
Companionship, value of, 15. 
Compresses, 186. 
Condensed milk, 140. 
Condy's fluid, 67. 
Confinement, 70. 

aperients after, 78. 

convalescence from, 76. 

diet after, 77. 

discharge after, 79. 

douching after, 80. 

first stage of, 72. 

food during, 72. 



Confinement, normal progress after, 82. 

position after, 81. 

premature, 56. 

preparations for, 61. 

preparation of bed for, 68. 

probable date of, 20, 21. 

second stage of, 73. 

third stage of, 74. 

Congenital defects, 162. 
Constipation, 239. 

diet in, 239. 

during pregnancy, 31. 

enemas in, 241. 

in infants, 202. 

treatment of, 31, 32, 202, 239. 

Constitutional diseases, 266. 

Contents of womb before miscarriage, 

51. 
Convalescence from confinement, 76. 

from miscarriage, 53. 

diet during, o4. 

Convulsions, 218. 

treatment of, 218. 

Cord, umbilical, separation of, 192. 
Coronal suture, 103. 
Cough during dentition, 213. 
Counter-irritation, treatment by, 186. 
Course of premature confinement, 57. 
Cow's milk, fresh, 139. 

condensed, 140. 

Cradle, 68, 124. 
Craving for alcohol, 13. 

for food in pregnancy, 22, 23. 

for unwonted articles of food, 23. 

Croup, false, 214. 

Curvature of spine in girls, 159. 

D 

Dancing as an exercise, 158. 
Defects, congenital, 162. 

of eyes, 166. 

Deficiency of fat in diet, 153. 
Dentition, disorders of, 210. 

first, 109. 

nervous system during, 210. 

second. 113. 

Depression of nipple, 87. 
Desquamation of skin of infants, 194. 

of skin after confinement, 83. 

stage of, 249. 

Development of child, 102. 

lacteal functions of mother, 86. 

of walking powers of child, 110. 

Diapers for infant, 68, 123. 



INDEX. 



287 



Diapers for mother, 66. 

Diarrhoea i n children, 237. 

during dentition, 213. 

in infants, 197. 

Diathetic diseases, 266. 

Diet after confinement, 77. 

■ — during convalescence from mis- 
carriage. 54. 

during pregnancy, 30. 

importance of regularity in, 16. 

in threatening miscarriage, 49. 

Difficulties of digestion in infants, 137. 

Digestion, difficulties of, in infants, 137. 

painful, in infants, 92. 

Digestive organs, disorders of, 236. 

Dilution required by cow's milk, 139. 

Diphtheria, precautions relating to, 227. 

Diphtheritic inflammation, 225. 

Discharge after confinement, 74, 79. 

after miscarriage, 53. 

of blood in miscarriage, 47. 

- — of blood in premature confine- 
ment, 58. 

fetor of, after confinement, 79. 

from ear, 221. 

vaginal, 42. 

Discomfort in breasts, 90, 93. 

Disease of womb as cause of mis- 
carriage, 46. 

Disinfectants, abuse of, 191. 

in infectious disease, 190. 

Disorders of dentition, 210. 

of pregnancy, management of, 29. 

Distention of veins of leg, 39. 

Disuse of faculties, results of, 156. 

Doctor, selection of, 61. 

Douche, vaginal, 65. 

Douching after confinement, 80. 

Drainage of house, 64. 

Draw-sheet, 69. 

Drill, military, 158. 

Dry heat, application of, 183. 

Duration of nursing, 98. 

of pregnancy, 20. 

of rest after miscarriage, 53. 

D' v+ ies of a nurse, 168. 
— of married life, 11. 



E 



Ear, abscess of, 219. 

discharge from, 331. 

foreign bodies in, 279. 

syringing of, 189. 

Earache, 221. 



Early miscarriage, 44. 

motherhood, 76. 

Eczema, 246. 

Effects of rheumatism, 13, 367. 

of stimulants, 17. 

Effort and rest, 157. 

Elastic stockings, 40. 

Emergencies, management of, 275. 

Emergency basket, 280. 

Enema syringe, 33. 

Enemas, administration of, 33. 

composition of, 34. 

in constipation, 241. 

quantity of fluid in, 34. 

Enlarged lymphatic glands, 268. 

tonsils, effects on respiration, 228. 

Enlargement of areola of breasts, 24. 

of breasts, 24. 

Errors in children's diet, 153. 
Eruption, stage of, 249. 
Eruptions, non-infectious, 241. 
Eruptive fevers, infectious, 247. 
Erythema, 200. 

papulatum, 241. 

Excess of farinaceous food in diet, 153. 

of nitrogenous food in diet, 154. 

Excretion from bowels of infant, 104. 
Exercise, artificial means of, 158. 

bicycle, 16. 

out-door, 126. 

riding, 16. 

rowing, 16. 

walking, 16. 

External applications in children, 180. 

piles, 41. 

signs of pregnancy, 19. 

Eye, application of lotion to, 189. 

defects of, 166. 

foreign bodies in, 279. 

Eyelids, inflammation of, 204. 



P 



Faintness, 35. 
False croup, 214. 

treatment of, 216. 

False pains, 71; 
Family syringe, 65. 
Farinaceous foods, 143. 
- — excess of, 153. 
Fat, deficiency of, 153. 
Feeding bottles, 142. 
Feeding by hand, 144. 

cup, 67. 

Fees, medical, 62. 



288 



INDEX. 



Fees of monthly nurses, 63. 
Fever as cause of miscarriage, 46. 
Feverishness after confinement. 84. 
Fevers, infectious eruptive, 247. 

stages of infective, 249. 

Fires, coal, 175. 

gas, 176. 

First dentition. 109. 

stage of confinement, 70. 

Fissures on nipple, 89. 

Flannel, qualities of, 177. 

" Flooding " after confinement, 79. 

Florence Nightingale, aphorism of, 172. 

Fetor of discharge after confinement, 

79,84. 
Fomentations, 180. 
Fontanelles, 103. 
Food during confinement, 72. 

of invalids, 178. 

Foods, farinaceous, 143. 
Foreign bodies in ear, 279. 

in eye, 279. 

in nose, 279. 

Formation of moral character, 161. 

Frequency of suckling. 91, 137. 

Fresh air, value of. for children, 125. 

Friction, how to apply, 187. 

Frontal suture, 103. 

Fulness of breasts after confinement, 

89. 

after miscarriage, 54. 

of stomach, sense of, 23. 



Garters, 131. 
Gas fires. 176. 

effects of, 176. 

Gastric derangements of pregnancy, 22. 
General care of child. 120. 
Glands, enlarged lymphatic, 268. 

scrofulous, 269. 

Glycerine, injection of, 34. 

syringe, 35. 

Croat's milk, 150. 
Gravel in urine, 201. 
Growth of infant, 105, 106. 
Gums, affections of, 211. 



Hemorrhage after confinement, 79. 

from wounds, 277. 

Haemorrhoids, 40 
treatment of, 42. 



Hand-feeding, 144. 
Harelip, 164. 
Health of the mind, IT. 
Heartburn. 23. 

treatment of, 30. 

Heat, application of dry, 183. 

artificial sources of, 175. 

Heating of bedroom, 64. 
Heat-spots, 241. 
Heights of children. 106. 
Helps to convalescence after confine- 
ment, 84. 
Hereditary tendency to indigestion, 13. 

to rheumatism, 13. 

transmission of disease, 13, 

Hernia, 164. 

inguinal, 165. 

umbilical. 165, 193. 

Horseback exercise, 16. 
Humanized milk, 146. 
Hygiene of invalid, 172. 

of sick-room, 172. 

Hypermetropia, 167. 



Ice-bags, 184. 

Ice. how to break, 185. 

how to keep. 185. 

Imitative powers of children, 14. 
Imperfections of vision. 166. 
Imperforate condition of lachrymal 

ducts. 166. 
Importance of rest, 159. 
Incised wounds, 277. 
Incisor teeth, 109, 113. 
Increase in size of abdomen, 27. 

management of. 36. 

Incubation, stage of, 249. 

Indications of intelligence in infante. 107 

of threatening miscarriage, 47. 

Indigestion, acute. 236. 

chronic, 236, 237. 

in infants. 92. 

signs of, in infants, 92, 93. 

treatment of, 237. 

Infants' breasts, inflammation of, 193. 

difficulties in sucking. 136. 

Infant life, minor troubles of, 192. 
Infectious diseases, disinfectants in, 190. 

diseases, isolation during. 190. 

eruptive fevers, 247. 

fevers, stages of, 249. 

Inflamed piles, treatment of. 42. 
Influence of maternal example, 13. 



INDEX. 



289 



Inguinal hernia, 165. 
Inherited tendencies, 13. 
Injection of glycerine, 34. 
Insufficiency of breast-milk, 90, 139. 
Intelligence in infants, 113. 
Intertrigo, 200, 201. 
Invalid, cleanliness of, 177. 

■ clothing of, 177. 

food of, 178. 

washing of, 177. 

Invasion, stage of, 249. 

Irritant plasters, 187. 

Irritation, vaginal, 42. 

Isolation in infectious diseases, 190. 

Itch, 264. 

Itching from vaginal discharge, 42. 



Jaundice, 194. 

K 
Kingsley, Rev. Charles, 14. 

L 

Lacerated wounds, 278. 

Lachrymal ducts, closure of, 166, 205. 

Lacteal functions, development of, 87. 

Later married life, 282. 

Laxative medicines, 241. 

Light of sick-room, 176. 

Linia? albicantes, 37. 

liniments, 187. 

Linseed poultices, 181. 

~.ong-sightedness, 167. 

Lotion, application to infant's eyes, 204. 

for vaginal discharge, 42. 

Lotions, 189. 

Lymphatic glands, enlarged, 268. 

M 

Management of threatening miscar- 
riage, 50. 
Marks, mothers', 162. 
Married life, duties of, 11. 

life, later, 282. 

life, responsibilities of, 11. 

Maternal example, influence of, 14. 

Maternity, probability of, 12. 

Measles, 254. 

Meconium, 135. 

Medical attendant, selection of, 61, 

fees, 62. 

practices, 62, 



Menopause, 282. 

Menstrual discharge in girls, 115. 

Menstruation, cessation of, 19. 

recommencement of, 98. 

Mental anxiety as cause of miscarriage, 
46. 

health at puberty, 118. 

peculiarities during dentition, 220. 

training, 160. 

Merino, qualities of, 177. 
Micturition, crying during, 202. 

painful, 202. 

Military drill, 158. 
Milk, ass's, 149. 

condensed, 140. 

goat's, 150. 

humanized, 146. 

peptonized, 148. 

sterilized, 146. 

teeth, 110. 

Mind, health of the, 17. 
Minor troubles of life, 18. 
Miscarriage, 44. 

causes of, 45. 

convalescence from, 53. 

discharge of blood in, 47. 

indications of, 47. 

management of, 50. 

preventive treatment of, 49. 

progress of, 50. 

Mixtures, administration of, 179. 
Mixed medical practices, 62. 
Moisture, application of, 186. 
Molar teeth, 110, 113. 
Monthly nurse, 62. 

nurses, fees of, 63. 

Moral character, formation of, 161. 
Morning sickness, 22. 

treatment of, 30. 

Mother in relation to infant, 86. 
Motherhood, early, 76. 
Mothers' marks, 162. 
Mouth, affections of, 211. 
Movement of child, sensation of, 2$ 
Mumps, 257. 

Musical calisthenics, 158. 
Mustard plasters, 187. 

poultices, 188. 

Myopia, 167. 



N 



N^evi, 162. 

Narcotic drugs, place of, 43. 

Natural food of infant, 135. 



290 



INDEX. 



Necessity of rest in miscarriage. 49. 
Nerve stimulants. 153. 
Nettle-rash. 244. 
Night-caps. ISO. 
Night-dresses of children, 130. 
Nightingale. Florence, 172, 
Night terrors. 219. 
Nipple, depression of. 87. 

fissures on, 89. 

shield, 88. 

tenderness of, 89. 

Nitrogenous food, excess of. 154. 

Non-riability, 56. 

Normal development of child, 101. 

frequency of pulse, 170. 

frequency of respiration, 169. 

progress after confinement. 82. 

temperature of body, 171. 

Nose, bleeding from, 280. 

foreign bodies in, 279. 

Nurse, accommodation of, 63. 

duties of, 168. 

monthly, 62. 

Nursing of children during illness, 168. 

duration of, 98, 99. 

Nutrition of the child, 135. 



Oatxeal poultices, 181. 
Objective signs of pregnancy, 19. 
Observation of invalid, 168. 

of pulse. 170. 

of respiration, 169. 

Obstacles to suckling infant, 85. 
Outdoor exercise for children, 126. 
exercise for wives, 16. 



Faistttl contractions of womb, 70. 

digestion iu infants, 92. 

Pain in miscarriage, 48. 

in stomach, 23. 

Pains, false, 71. 

Parasitic diseases, 263. 

Parotitis. 257. 

Peculiarity of children's digestive 

organs, 15^. 
Peptonized milk, 148. 
Perambulators, 126. 
Permanent teeth, 113, 
Pertussis, 259. 

Physical training of child, 156. 
Pigmentation of areola of breast. 24 



Piles, 40. 

external, 41. 

internal, 41. 

treatment of. 42. 

Placenta, description of, 72. 
Plasters, irritant. 1^7- 

mustard, 187. 

Position after confinement, 81. 
Poultices. 181. 

bran. 181. 

bread. 182. . 

linseed, 181. 

mustard, 188. 

oatmeal, 181. 

starch, 183. 

Powders, administration of. 179. 

for infant- 

Practices, medical. . 
Precautions before confinement. 69. 
Pregnancy, binder in, 43. 

diet during. 30. 

durati: n 

external signs of, 19. 

gastric derangements of, 22. 

objective signs of, 19. 

sleeplessness in, 43. 

symptoms ■: I 

Premature confinement, 56. 

causes of. 56. 

course of. 

Preparation of bed for confinement. 68. 
Preparations for confinement, 61. 
Preventive treatment of miscarriage, 49. 
Probability of maternity. 12. 
Progress of miscarriage, 51. 
Prolapse of bowel, 238. 
Puberty in boys, 118. 

in girls. 115. 

Pulse, how to feel. '.' 1 

normal frequency of, 170. 

Q 

QricKExrxG, 26. 

Quiet after confinement, importance 
of, 77. 



Recommescexext of menstruatk 

.' tH. 
Requisites for infant 

for the mother, 65. 

Respiration, normal frequency of, 169. 

observation of. 169. 

: Abilities of married life, 11, 



INDEX. 



291 



Kest and effort, 157. 

Rest, importance of, 159. 

Restlessness at night during dentition, 

212. 
Results of disuse of faculties, 156. 
Rheumatism, 266. 

effects of, 13, 267. 

hereditary tendency to, 13. 

Rickets, 271. 
Riding exercise, 16. 
Ringworm, 263. 
Rocking cradles, 68. 
Roseola, 243. 

epidemic, 256. 

Rose-rash, 243. 
Rotheln, 256. 
Rowing exercise, 16. 
Rupture, 164. 



Safety-pixs, 67. 

Sagittal suture, 103. 

Sand in urine, 201. 

Sanitary towels, 66. 

Scabies, 264. 

Scalds, 276. 

Scarlatina, 252. 

Scarlet fever, 252. 

Scrofula, 268. 

Scrofulous glands, 269. 

Sea-bathing during pregnancy, 43. 

Second dentition, 113. 

Second stage of confinement, 73. 

Secondary areola of breast, 25. 

Secretion from kidneys of infant, 105. 

Secretions of skin, 173. 

Select medical practices, 62. 

Selection of medical attendant, 61. 

Sensations of movement of child, 27. 

Sense of fulness of stomach, 23. 

of weight, relief of, 36. 

Senses, training of, 160. 

Shivering after confinement, 76, 84. 

Shoes, 131. 

Short-sightedness, 167. 

"Show,'" 71. 

Sickness in babies, 138. 

morning, 22. 

Sick-room, cleanliness of, 172. 

light of, 176. 

sunshine in, 176. 

temperature of, 175. 

ventilation of, 173, 



Signs of indigestion in infants, 92. 

of pregnancy, 19. 

Sitting up after confinement, 82. 

Size of infants, 102. 

Skin, desquamation of, after birth, 194. 

of infants, 124 

Sleep required by infants, 108. 

Sleeplessness in pregnancy, 43. 

Small-pox, 252. 

Snoring, 228. 

Soaps, 67. 

Solid animal food, 152. 

Sources of heat, 175. 

Sourness of milk, prevention of, 140. 

Special senses, training of, 160. 

Speech, 112. 

Spine, curvature of, in girls, 159. 

Sponges, 66. 

artificial, 66. 

Spongio-piline, 188, 189. 

Sprains, 275. 

Squinting, 167. 

Stages of infectious fevers, 249. 

Starch poultices, 183. 

Sterilized milk, 146. 

Stimulants, effects on children, 153. 

results of undue indulgence in, 17. 

Stockings, elastic, 40. 

Stomach, capacity of infant's, 137. 

cold affecting, 232. 

pain in, 23. 

Stoups, turpentine, 188. 
Stretching of skin of abdomen, 37. 

of breasts, 37. 

Strophulus, 194. 

Stump of cord, bleeding from, 121. 
Subjective symptoms of pregnancy, 19. 
Substitute for mother's milk, 136. 
Sucking, difficulties in, 136. 

process of, 87. 

Suckling, duration of, 96. 

frequency of, 90, 137. 

obstacles to, 85. 

Sunshine, effects of, 176. 

in sick-room, 176. 

Supernumerary fingers, 164. 

toes, 164. 

Susceptibility to infection after confine- 
ment, 84. 
Suspenders, 131. 

Sutures of infant's head, 102, 103. 
Sweeping of bedroom, 64. 
Swelling of feet during pregnancy, 38. 
of legs during pregnancy, 38, 



292 



INDEX. 



Swinging: as an exercise, 158. 
Symptoms of pregnancy, 19. 
Syringe for injection of glycerine, 35. 

the family enema, 33. 

Syringing after miscarriage, 54. 
of ears, 189. 



Tea, in diet of children, 153. 
Tears or wounds, 278. 
Teeth, milk, 110. 

permanent, 113. 

wisdom, 115. 

Teething, 109. 
Temperature, normal, 171. 

of artificial food, 142. 

of invalid, 170. 

of sick-room, 175. 

Tenderness of nipple, 89. 
Thermometer, clinical, 171. 

for sick-room, 175. 

Third stage of confinement, 74. 
Thread-worms, 265. 

affections of, 223. 

applications to, 189. 

catarrhal inflammation of, 224. 

Throat, description of, 223. 
Thrush, 195. 

cause of, 196. 

treatment of, 197. 

Tonsillitis, subacute, 224. 

treatment of, 226. 

Tonsils, enlargement of, 228. 
Towels for infant, 67. 
Training, mental, 160. 

of special senses, 160. 

physical and mental, 156. 

Tricycle exercise, 16. 
Troubles of infant life, 192. 

of life, minor, 192. 

Turpentine stoups, 188. 



Umbilical cord, care of, 121. 

cord, separation of, 192. 

hernia, 165, 193. 

Urticaria, 244. 

Use of binder in sleeplessness, 43. 

V 
Vaccination, 205. 
Vaginal discharge, 42. 

irritation, 42. 

Value of companionship, 15. 

Varicella, 249. 

Varicose veins, 39. 

Variola, 252. 

Veins, distention of, 39. 

Ventilation of sick-room, 173. 

Viability, 56. 

Vision, imperfections of, 166. 

Vomiting, 22. 

W 
Walking exercise for wives, 16. 
Walking powers of infant, development 

of, 110. 
Washing of infant, 120. 

of invalid, 177. 

Waterbrash, 30, 
Waterproof sheeting, 68. 
Weaning, 98, 99. 
Weights of children, 106. 

of infants, 101. 

Wet nurse, 150. 
Whooping-cough, 259. 
Wisdom teeth, 115. 
Womb, contractions of, 70. 
Worry as cause of miscarriage, 46. 
Wounds, incised, 277. 
lacerated, 278. 



Yellow-gum, 194, 195. 



THE HAGNETIC CROUP TIPPET. 

A Valuable Nursery Article, No, 47, 

which, when tied about the neck of a child 
during sleep, is WARRANTED IN ALL 
CASES TO PREVENT CROUP. 

Invented by Dr. E. B. Foote and sold by 
him for twenty years. It has proved to be per- 
fectly satisfactory in thousands of families, and 
many mothers write that it saves fifty dollars in 
doctors' bills every year. Sent by mail for $2. 

A pamphlet on CROUP, with 

ADVICE AND PRESCRIPTIONS, 

FOR TEN CENTS. 




ABDOMINAL SUPPORTERS Jo. 21 



pecially to 
pregnancy ; 
anti-version. 



are of great comfort to 
many women of pendu- 
lous abdomen, and es- 
those who feel burdened with 
also in cases of "falling" or 
Send measure about thighs 




and lower abdomen. Price, $3 and $5. 




FAMILY SYRINGES. 

DR. FOOTE'S — The ordinary style, with rubber 
bulb and tubes, and rubber pipes. No. 22, by mail, $1. 

THE ARTERIAL-ACTION, CONTINUOUS FLOW, 
FAMILY SYRINGE is a first-class article, all parts of 
fine rubber, and no loss of valves can occur ; joints 
tight. No. 23, by mail, $2. 
FOUNTAIN SYRINGES are the lazy man's (or woman's) friend; no bulb to 
squeeze, for the flow of water is made strong or weak 
by hanging bag high or low. No. 25, two-quart size. 
$1.50; No. 26, four-quart size, $2.50; postage, 25c. An 
extra large "irrigator" pipe (No. 27), for vaginal cleans- 
ing, costs 50c. more. 

All the above Family (or Fountain) Syringes 
are generally useful for child or adult, male or female, 
in health or disease, for cleanliness or emergencies; 
but we call the attention of married women to an ar- 
ticle for their own, exclusive use, viz.: 

DR. FOOTE'S SANITARY SYRINGE, for thorough cleansing of vagina, and 
the economical use of medicinal washes without waste ; also for hot injections, 
when heat is the thing prescribed, a little hot water can be 
made as effective as four quarts. It works by injection 
and suction, and without mussing or "slopping over." 
Comes in three sizes, large, small, and medium, and the 
latter is always sent, unless others are specified. No. 28, price $2, by express 
only (as the cone is of glass). We can also furnish the Ladies 1 Syringe, all soft 
rubber, with short cone, that works much same way, for $2.50, by mail prepaid. 







Soluble Sanitary Tampons, No. IO. 

Self=Cure — Home Treatment — For Women. 

A form of '* local trealment " or "direct medication " adapted 

to all forms of " Female Weakness,' 1 Relaxation, Prolapsus, 

Versions and Flections ; Chronic Congestion or Innamrna 

tion of Womb or Ovaries; Ulceration or Granulation of 

Neck of Womb ; Menstrual Pains. Irregularities, etc. 

Leucorrhcea, or Whites. 

The Soluble Sanitary Tampons are recommended in all cases where there are 
such symptoms as loss of tone or feeling, dragging or bearing down sensations, 
backaches, pains in the groins or distress between the groins, catarrhal dis- 
charges, profuse, scant, or painful periods. //* short, they are offered as a reliable 
substitute for the old methods of treatment by Caustic*. Catting, and Pessaries, in 
a great variety of women's ailments where severe measures only make matters 
worse, and where only mild measures ovght to be used. They are curative in 
cases of Sterility or Apathy due to any of the diseased conditions named above. 

$1 per box, mailed. (No. 10 and No. work well together, used in alternation.) 

Pelvic Pine=Cones, No. O, 

are "' simply wonderful** in their cure of all cases of Pelvic Disorders, attended 
with heat, soreness, weakness, irritation, inflammation of the rectum, bladder, 
prostate gland, urethra?, seminal vesicles, womb, ovaries, etc. In cases of CON- 
STIPATION, PROSTATORRHflA, SPERMATORRHEA, LEUC0RRHOIA, PRURITUS, CYSTI- 
TIS, VESICULITIS, OVARITIS, PILES, SPASM, HEAT, PAIN. Dr. Foote's Pelvic Pine 
Cones applied, as they can be directly to the seat of the disease, give prompt reluf 
from some of the most irritating symptoms that worry suffering men and women. 
Trial Convinces. Price, by mail, 50c. per box. 

Skin and Toilet Articles. 

No. 31. Boracic Acid, to improve complexion, relieve itching, and minor erup- 
tions, red spots, scales, and dandruff (a fine shampoo). 50c. per cake, mailed. 

No. 32. Ichthyol Soap, for salt-rheum, ring-worm, unnatural redness of nose 
or face, " skin worms," black-heads, pimples. 50c. 

No. 33. Anti-Parasitic Soap banishes all superficial parasites, animal or vege- 
table; fleas, ring-worm, itch insects, lice, " crabs. 1 ' and is useful against unclean 
eruptions (.syphilitic), ulcers, etc. Great for itching irritations. 50c. 

No. 34. Sanitary Caustic will gradually eat away warts, moles, and other ex- 
crescences without exciting inflammation or leaving scars. 50c. by mail. 

No. 35. Sanitary Emulsion, a moth and freckle lotion, to clear the complexion, 
which it does by erasing the color-patches, brown stains and deposits left by 
blood impurities, liver torpor, etc. It thoroughly cleanses the pores, dissolves 
hardened secretions, and in short helps "off with the old and on with the new"* 
cuticle. Mailed for 50c. 

No. 36. Depilatory, removes superfluous hair without any caustic effect, thus 
avoiding the injurious effect, of the ordinary chemical depilatories. $1 per box, 
by mail. 

No. 1. For threatened Baldness, poor growth of hair, and all scalp irritations. 
we offer our regular Magnetic Ointment (No. 1) as the best remedy, and can show 
the finest testimonials to its usefulness in this line. 25c, 50c, and $1. 

No. 37. Sanitary Powder— just the thing for sore feet, moist, itchy skin surfaces, 
chafing, etc. Handy for ladies' and babies' toilets; also for barbers, big and little 
shavers. Relieves tender feet, moist arm-pits, and many forms of skin disease 
needing a drying, disinfectant, soothing and real sanitary influence. Dispels Dis- 
agreeable Odors of the body; substitutes better odor. Price, 25c per box. 



THE MAGNETIC OINTMENT. 

It is a -positive cure for all sprains, bruises, burns, flesh wounds, sore throat, 
stiff neck, backache, broken breast, sore nipples, colic pains, cramps, earache, 
pains in all parts of the system; and greatly assuages the pains of hard and soft 
corns, boils, felons, carbuncles, rheumatism, neuralgia, etc. 

It is a reliable medicine for children , who should not be dosed with drugjs. This 
external medicine will answer in nearly every emergency in removing the ills com- 
mon to infants. Applied to the stomach it relieves wind colic, loss of appetite, 
sour stomach, etc. Applied to the bowels it softens excrementitious matter, re- 
lieving constipation. It also cures diarrhoea, by relieving the intestinal irritation 
which causes it, if applied to the bowels. It is a valuable remedy for the nursery. 
Every young mother should have it. 

It greatly promotes easy tabor and should be conveniently at hand. Invalua- 
ble to every woman, especially just before, during, and after confinement, for the 
relief of piles, cramps, abdominal muscular pains, excessive after-pains, sore nip- 
ples, broken breasts, etc.. etc. 

Price, by mail, prepaid, in 4-oz. can, $1.00; also 25 and 50 cent sizes. 

WHAT ITS FRIENDS SAY OF IT. 

FROM THOSE WHO HAVE TRIED IT AND ORDER MORE. 

For Everything.—" We cannot get along without your Magnetic Ointment, for it 
is the best medicine for everything that we ever used. One of our neighbors had 
sore breasts and my wife sent her some of it, which cured her in two days." 

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from my sick chamber to say your Magnetic Ointment is one of the best remedies 
for rheumatism, cuts, piles, carbuncles and corns that can be used. The more 
I use the Ointment the more / am astonished at its efficacy. For the good of our 
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MAGNETIC ANTI = BILIOUS PILLS. 

These Pills are an entirely vegetable substitute for mercury, and their action 
upon the liver is far superior to that of any drug. They are each electrically neg- 
ative, and when taken into the stomach they awaken the positive forces of the 
gastric juice to healthy action and attract the same forces of elimination to act 
upon the functions of the liver, causing a free discharge of bile into the intestinal 
canal, where its dissolving and lubricating properties soften the excrementitious 
matters and give them an easy and natural passage through the small intestines 
and lower bowel, while the properties of the medicine continue to act as a tonic 
upon all these enfeebled or inactive organs and canals. They infallibly cure bil- 
ious headache, ordinary or chronic constipation, want of tone of the stomach or 
bowels, promote digestion, cause healthy assimilation of nutriment, and, in fact, 
are the best family pill in use. 

Price, single box, by mail, 35 cents; large box, $1. 

WHAT PEOPLE SAY OF THESE PILLS. 

The following are quotations from bona-fide letters on file in Dr. Foote's 
office, but the names are omitted, as they are extracts from confidential letters: 

" Your Anti-Bilious Pills are the best I have ever taken, and I would not be 
without them for ten times what they cost; in fact, I think they have done more 
for me than any other medicine." 

" Please forward another dozen boxes of your Pills. They are the best I have 
ever used, and I have tried several kinds." 

Address, 

DR. FOOTE'S SANITARY BUREAU, 

129 East 28th Street, NEW YORK. 



A FEW LAST REMARKS 

ON 

MEDICAL SPECIALISTS— THEIR FUNCTIONS AND METHODS. 

The following excerpt from the Philadelphia Polyclinic is given as 
evidence of growing rationalism in old-school circles on the subject of 
specialism in modern medical practice. The necessity of some means 
of advertising as an accompaniment of its development is acknowl- 
edged, and the propriety of direct or straightforward methods, in place 
of prevalent roundabout ways, is pretty distinctly intimated. Maybe 
some day we will awake to find that in this, as well as other progres- 
sive ideas, we have been simply leading the procession and setting the 
style, when some thought we were pursuing an erratic or irregular 
course : 

"The increase of specialism can only go on as the specialist is able 
to draw on a larger number of people for his support, and to do this he 
must in some way acquaint that larger number with himself and his 
work. Extending this acquaintance is the legitimate function of 
advertising. Specialism and advertising of some sort necessarily go 
together. This connection is neither recent nor local, nor temporary. 
"When the doctor gave up his farming or storekeeping, he put out a 
sign and got a degree, setting forth what sort of work he expected to 
do, and assumed a professional demeanor, all calculated to extend in 
the community the knowledge of what service he was prepared to 
render. And with large numbers of people to be reached, and new 
means at hand by which to inform them of his existence, no ' conserva- 
tism ' on the part of those who fail to recognize the continuous forward 
flow of events will prevent the adoption of new methods of advertising. 

"By the later specialists, teaching and hospital positions have been 
eagerly sought for their supposed advertising value, and the article in 
the medical journal has become a part of the routine task of the aspir- 
ant in this direction, until the profession and the community are both 
suffering from the multiplicity of medical schools and hospitals, and 
legitimate medical literature is drowned in the torrent of medical writ- 
ing. And still the professors and holders of official positions are cer- 
tifying nostrums and 'mineral waters,' being interviewed by the 
ubiquitous reporter, and in every way struggling to have their names 
floated to a still larger circle of possible patients. 

"There can be no question but that specialization, in so far as it is 
normal, is progress ; that the community is better served, more cheaply 
and satisfactorily served, by legitimate specialists than by jacks-of-all- 
trades. Specialism is bound to extend, and for the evils its attempts at 
advertising now inflict, no more legitimate remedy will be found than 
proper and efficient means of accomplishing this necessary function. 

1224 



MEDICAL SPECIALISTS. 1 225 

When Dr. Smith can otherwise let the community know that he is pre 
pared and desires to practise ophthalmic surgery, his desire for a pro- 
fessorship or a hospital service, irrespective of his aptitude for teaching 
or his interest in studying hospital cases, will be greatly moderated ; 
the true teacher and clinical student will have a correspondingly better 
chance, and mushroom medical schools and new hospitals will be less 
of a burden in the land." 

The specialist is confronted with another prejudice existing to 
some extent in the public mind and which is professedly, though we 
think not sincerely, entertained by the average physician. It is that a 
specialist living, say in the city of New York, cannot successfully 
attend to some case of chronic disease in Chicago, San Francisco, or 
Australia. It will be conceded instantly that in all cases of acute dis- 
ease a physician must be close at hand. In five minutes' time the 
symptoms may change in such a way as to require immediate attention. 
But this is not true of chronic diseases. There are many having 
chronic diseases who will even assume to treat themselves by resorting 
to some domestic remedies, or by going to the drug-store and purchas- 
ing some proprietary nostrum. With no knowledge of medicine what- 
ever, they guess at the nature of the complications affecting them, and 
then guess again as to the remedy which would probably be the best 
suited to their complaints. It need not be said that this is tampering 
with one's self. A person is quite at liberty to pursue this haphazard 
course if he chooses to do so, but it is perfectly proper to pronounce 
such a course quite imprudent, to say the least manifestly indiscreet. 
But when such a person avails himself of the wonderful facilities of 
our civilization, the quick mails and express, it is clearly the very 
thing to do, for a person having some disease which has resisted home 
skill to apply to a noted specialist who has mainly acquired his celeb- 
rity and good reputation through his medical success. With a practice 
reaching out from his office to all the States and Territories, he can 
hardly fail to acquire an experience which will enable him to perform 
what many will regard as miracles. A person having a chronic disease 
of a difficult character is infinitely better off in the hands of a noted 
specialist one hundred or one thousand miles away, than he can be 
under the supervision of one whose time and professional skill is mostly 
employed in the treatment of a class of ills as little like those of a 
chronic character as a mule is like a horse or a goat is like a jackass. 
We therefore say that an invalid who has been suffering for months 
and perhaps for years with a supposed incurable malady is fully justi- 
fied, in the light of reason and common sense, in opening communica- 
tion with one having a wide range of experience in the treatment of 
such ills. 

E. B. FOOTE, M.D. 



i- , 26 ADVERTISEMENTS. 

Dr. E. B. FOOTE and His Assistants 

May be Consulted daily, from o a. m. to 6 p. m. 

(excepting Sundays), 

In the English or German Languages, 
at their office, 

120 LEXINGTON AVENUE, Cor. of EAST 28th STREET, 

NEW YORK CITY. 



For convenience and permanence of location. Dr. Foote purchased, in 1967, 
the property above mentioned, and here his professional work has been carried 
on for over thirty years. It is within one short block of the Third or Fourth Avenue 
surface railroads, and a station of the Third Avenue elevated road. The Lexing- 
ton Avenue trolley-cars run by the door— a branch of the Broadway route. It is not 
far from the Grand Central Depot, at Forty-Second Street and Fourth Avenue, and 
by the above named car-lines and transfers it is easily reached from the routes of 
travel which land rbeir passengers in New York by ferry. Dr. Foote's office is but 
a few steps from Madison Square Garden. 

In answer to numerous inquiries, Dr. Foote takes this opportunity to in- 
form correspondents that he cannot accommodate patients with board. There 
are, however, hotels and boarding-houses within a convenient distance, fashion- 
able and expensive, and unfashionable and comparatively cheap, where invalids 
can obtain accommodations according to their means. 

IN THE TREATMENT OF CHRONIC DISEASES, 

Dr. Foote makes use of all the remedial agencies recommended in this work. 
Each disease is attended according to its individual peculiarities, and such treat- 
ment prescribed as. in all human probabilities, will most likely insure success. 

Invalids preferring to consult by letter are referred to page 761. where a list of 
questions will be found, answers to which will enable the author, by a careful 
analysis of symptoms, to form a correct opinion of the nature and curability of the 
oase. 

ALL CONSULTATIONS, 

In person or by letter, in the English or German languages, are free, with 
the exception of "those relating to matters referred to on pages 1080 and 1197. All 
consultations, either personally or by letter, are strictly confidential. This rule 
has been so faithfully observed' by the author in his long and extensive practice, 
that no person who has ever consulted him can complain of its infraction in a 
single instance. 

All letters are promptly answered when there is any reply called for. This is 
an invariable rule; consequently anyone who addresses the author without 
receiving within reasonable time an acknowledgment, may rest assured that 
either the letter of the correspondent or the reply thereto has miscarried. 

RESIDENTS OF FOREIGN COUNTRIES, 

England, France, Germany, and even Japan, China, Australia and South Africa* 
where this book has already found a wide circulation and made hundreds of 
friends, have availed themselves of the offer of free consultation by mail, and 
others are herebv invited to consider themselves welcome to seek advice in the 
same manner. There are many forms of chronic disease which can be successfully 
treated afar off, as abundant letters of evidence in hand attest. 



F 



ADVERTISEMENTS. 1227 

SANITARY ARTICLES, INSTRUMENTS, MEDICINES, Etc. 

SUPPLIED BY MAIL OR EXPRESS FROM 

Dr. Foote's "Sanitary Bureau," 129 E. 28th St., N. Y. 

[Make money orders, etc., payable to Dr. H. T. Foote, Manager.] 
(A more complete descriptive list or catalogue sent free.) 

EYE-SHARPENER, or Self Sight Restorer, for the restoration of sight impaired 
by age. LSee page 734.] Sent by mail, postage paid, on receipt of $2. Agents 
wanted. 

MAGNETIC CROUP TIPPET.— Warranted to prevent croup. A valuable, sim- 
ple, and perfectly comfortable nursery article, which has stood the test of 
forty years' trial, given perfect satisfaction and insured welcome relief in thou- 
sands of families. Sent by mail for $2. (A pamphlet of advice and prescriptions 
fo rlOcts.) 

AMILY SYRINGES.— A plain, compression bulb, Family Syringe, with three 
rubber pipes, by mail for Si. 
"THE ARTERIAL ACTION, Continuous Flow, all rubber Syringe (pipes of hard 
I rubber) ; a first-class article, for $2.00, by mail. 

FOUNTAIN SYRINGES, with three hard rubber pipes, two-quart size for $1.50, 
and four-quart size for $2.50; postage 25 cents extra. 
SANITARY SYRINGES, for married women, only, are great for thorough cleans- 
ing and use of medicinal washes without waste; by express only, for $2.00. 

ELECTRO-THERAPEUTIC MACHINES— the best medical batteries; less expen- 
sive and better than "magnetic 1 ' or "electric" belts, bands, medals, gar- 
ments, etc., most of which are useless clap-trap. Elegant, practical, and handy 
machines; $8, $12. 

HICK'S PATENT AIR-INFLATED RUBBER TRUSS PADS.— One cure pad and 
one relief pad— can be adjusted to any truss. Price $3.00 each, or the pair for 
$5, by mail, prepaid. The " cure " is as sure cure as any "'appliance " offered at 
ten times the cost, and the "relief " pad is the most comfortable one that can be 
worn in any case. 

TRUSSES, SINGLE AND DOUBLE.— Single truss, fitted with two of Hick's pads, 
I $12; double truss, fitted with four pads, $15. When ordering any truss send 
measurement in inches around the body at the level of the hips. These are fine 
goods, well finished, neatly covei'ed and durable. 

PHIMOSIS INSTRUMENT.— For the cure of congenital or acquired Phimosis 
[contracted foreskin] without circumcision, cutting, tearing, or pain. An 
instrument which can be safely put in the hands of the patient himself to effect 
his own cUre, and one which cannot fail when intelligently applied according to 
directions. Price, by express, $10. 

SPERMATORRHEA RING.— An easily adjusted instrument to give the sleeper 
timely warning in case of threatened involuntary loss. By mail, prepaid, $1.50 . 

SCROTAL SUPPORTERS FOR GENTLEMEN.— A comfortable suspensory for 
relaxed parts; absolutely indispensable in VARICOCELE, invaluable in all 
cases of swelling or disease of the testicles, and always an aid in the cure of Sper- 
matorrhoea. Simple suspensory for support, 75 cents, by mail, prepaid. One-string 
compression supporter, the improved supporter. $1.50. Three-string bandage, for 
bad cases of varicocele, hydrocele, and orchitis [inflamed testicle], $3. Each 
style made in three sizes ; small, medium, and large. [Read Chapter VIII. (Dis- 
ea ses of Men) of this book.] 

PILE COMPRESSOR.— For external [protruding] piles and falling of the rectum; 
a source of great comfort to many sufferers. [See page 449.] By mail, 
reduced from $10 to $5. In ordering sen d waist measure to insure right size. 

SHOULDER BRACES AND ABDOMINAL SUPPORTERS.— For both sexes. 
When ordering aishoulder-brace send measurement around chest, under arms, 
and around waist; also from snoulder blade to waist. Price, by mail, prepaid, 
$2; steel back brace, to order, $5. When ordering abdominal supporter send 
waist measurement and also largest, abdominal girth. Price, $5 by mail. 

IMPREGNATING SYRINGE.— An instrument for facilitating conception in cases 
I of barrenness due to obstruction iu the neck of the womb. Price, with full 
directions, $5 by mail. 



I22S ADVERTISEMENTS. 

Dr. Foote's Standard Specialties 

Supplied by mail or express from 
Dr. Foote's Sanitary Bureau, 129 East 28th St., New York. 

(A More Complete Illustrated Circular sent free.) ■ 



No. 0, Pelvic Pine Cones, 



Direct local treatment for piles and constipation. 

A "wonderful relief "in all rectal diseases, anal fissure, etc. 

Also for prostatic, bladder, and deep urethral irritations. 

Works well with No. 10 in all " female complaints. 
Price by mail, 50 cents per box; twelve boxes for $5.00. 



No. 1 . Magnetic Ointment, 



Cures sprains, bruises, wounds, sore throat, stiff neck, 

Backache, sore nipples, colic, cramps, piles, corns, 

.Relieves rheumatism, salt rheum, boils, felons, 

Promotes easy labor. A boon to mothers. 

A valuable remedy for all infants' ills. 
Price by mail, sample, 25 cts.; 2 ozs., 50 cts. ; 4 ozs., $1. By .express only, at 
purchaser's expense, 16 ozs., $3. 

No. 2. Magnetic Catarrh Balm, 

Cures nasal catarrh, sore eyes and ears, chapped lips, 

Disinfects discharges, softens scabs, allays itching, 

Soothes irritable, inflamed mucous membranes. 
Price, 50 cts. per jar, by mail. 

No. 3. Magnetic Anti-Bilious Tablets, Entirely v f o meicW. 

Cure biliousness, sick headaches, chronic constipation, 

Liver torpor, sallowness, nausea, hemorrhoids, flatulence. 
Promote digestion, assimilation, pure blood. 

Stimulate elimination, cleanse entire system. 
Price 25 cts. by mail; large box, SI- 

No. 4. Tonic and Ague Tablets, Sanitary ToTmSi ™ ter barks; 

Cure chills and fever, dumb ague, all malaria. 

Loss of appetite, bloddlessness, weakness, blues. / 
Price by mail, 50 cts. per box of 90 tablets— 90 doses. 

No, 8. Anti-Rheumatic Tablets, A riNE kidnet tonic. 

Cure rheumatism, gout, sciatica, lumbago and all 

Headaches, heart, lung and skin diseases caused by 

uric acid in the blood; and Bright's disease. 
Price by mail, 50 cts. per box of 60 tablets. 

No. 10. Soluble Sanitary Tampons, stren ?n5sepfic healing ' 

Self-cure, home treatment for diseases or women. 

'• Direct medication " for misplacements, inflammation. 

Menstrual pains and irregularities, apathy, sterility, 

. Leucorrhcea, ulceration— a mild medicament. 
One box of tampons sufficient for one month, by mail, $1. Six boxes, $5.00. 

No. 1 1 . Magnetic Cramp Tablets, A soothin * ^SSSFop^™. 

Cure colic, dyspeptic headaches, pains and cramps, 

"Bowel complaints," scant and painful "periods." 
A great boon to women and children. 
Price by mail, 50 cts. per box of 90 tablets. 

No. 1 2. Magnetic Cough Tablets, A safe *? T °*£? opiate. 

Cure spasmodic coughs and nervous headaches, 

Neuralgia, nervous irritability, hysteria, and sleeplessness. 
Price by mail, 50 cts. per box of 90 tablets. 



ADVERTISEMENTS. 



1229 



100 Pointers for 5elf=Treatment. 



Abscesses, boils; Nos. 1, 3, 4, 8. 

Acidity of stomach; Nos. 3, 11. 

Acne (pimples); Nos. 1, 2, 3, 4. 

Ague ; Nos. 3, 4, 8. 

Amenorrhoea (suppressed or scanty pe- 
riods) ; Nos. 4, 10, 11. 

Asthma; Nos. 1, 4, 8, 12. 

Bad breath; Nos. 3, 4, 8. 

Baldness, dandruff; No. 1, pomade. 

Biliary colics; Nos. 3, 4, 8, 11. 

Biliousness (sallow skin, yellow tongue, 
constipation); Nos. 3,4. 

Bites of insects; Nos. 1, 2. 

Blood disorders; Nos. 3, 4, 8. 

Breasts inflamed ; No. 1. 

Bright 's disease (kidney) ; Nos. 4, 8. 

Bronchitis; Nos. 1 (to chest), 12. 

Bruises, burns, etc.; No. 1. 

Catarrh, nose, eyes, cars; Nos. 2, 3. 4. 

Chapping, chilblains, etc.; Nos. 1, 2. 

Cholera infantum; Nos. 1, 11. 

Chorea (St. Vitus"s Dance); Nos. 4, 1 :. 

Colds, coryzas; Nos. 2, 3, 4, 8. 

Confinement, to ease labor; No. 1. 

Constipation; Nos. 1, 3, 4, 0. 

Consumption (lungs); Nos. 1, 4, 12. 
Convulsions; Nos. 1, 3, 12. Hot baths. 
Coughs; Nos. 1 (to throat), 12. 
Cramps; Nos. 1 (to bowels), 11. 
Cystitis (inflamed bladder); Nos. 0, 1, !', 

and slippery-elm tea. 
Dengue, a malarial fever; Nos. 3, 4. 
Diarrhoea in infants; Nos. 1, 11. 
Dizziness (dyspeptic); Nos. 11, 3, 4. 
Dropsy; Nos. 3, 8. 
Dysentery; Nos. 1, 3, 11. 
Dysmenorrhcea (painful periods); Nos. 

0, 1, 10, 11. 
Dyspepsia; Nos. 3, 4, 11. 
Eczema (saltrheum); Nos. 1, 2, 3, 4, 8. 
Epilepsy; Nos. 4, 8, 11, 12. 
Eyelid inflammations; Nos. 1, 2. 
Far sight, " old eyes;" No. 48. 
Fevers; Nos. 4, 12. 
Fissure of lip or anus; Nos. 1, 2, 3. 
Flatulence; Nos. 3, 4, 11. 
Gastralgia, gripes; Nos. 1, 11, 12. 
Glands, enlarged; Nos. 1, 3, 4. 
Gonorrhoea; Nos. 1, 3, 4, 8. 
Gout; Nos. 1, 3, 4, 8. 
Gravel, uric acid ; Nos. 3, 4, 8. 
Hay fever; Nos. 2, 4, 12. 
Heartburn, water brash; No, 11, 



Headaches; periodical, liver and sto- 
mach, over eyes; Nos. 3, 4, 11. In 
rheumatic, gouty persons in back, 
head, or neuralgic; Nos. 3, 4, 8, 12. 
Malarial, periodic ; Nos. 3, 4. Nervous 
exhaustion; Nos. 4, 12. At menstrual 
periods ; Nos. 11, 12. On top of 
head; womb disease; Nos. 4, 10, 11. 

Hiccough ; Nos. 11, 12. 

Hoarseness; Nos. 1, 12. 

Hysteria; Nos. 4, 12. 

Incontinence of urine; No. 12. 

Itching; Nos. 1, 2, 4, 8, 31, or &3. 

Jaundice ; Nos. 3, 4. 

Kidney diseases; Nos. 1, 4, 8. 

Kidney colic; Nos. 8, 11, 12. 

Leucorrhoea (whites) ; Nos. 4, 10, 0. 

Lice; Nos. 1, 33. 

Liver torpor; Nos. 1, 3, 4. 

Lumbago; Nos. 1, 3, 8. 

Malaria, chills, fever; Nos. 3, 4. 

Nervous exhaustion; No. 4. 

Nervous irritability; Nos. 4, 12. 

Night-sweats; Nos. 1, 3, 4, 12. 

Nipples, sore, cracked; Nos. 1, 2. 

Pains, aches, soreness; No. 1. 

Piles (hemorrhoids); Nos. 0, 1, 2, 3, 15. 

Pleurisy, pneumonia; Nos. 1, 4, 12. 

Prolapsus of rectum; No. 1, and a salvp 
of tannin, alternating. 

Prolapsus (falling womb); Nos. 4, 10. 

Ringworm; Nos. 1, 32, 37. 

Sciatica; Nos. 1, 3, 4, 8, 12. 

Seat worms; No. 1, at night, and salt 
water injections mornings. 

Skin (scaly) diseases; Nos. 1, 3, 4, 8. 

Sleeplessness; Nos. 11, 12. 

Sore nipples, throat, sprains; No. 1. 

Stiff neck, stiff, lame back; No. 1. 

Stomach ache; Nos. 2, 11. 

Sunburn, freckles, blotches; No. 1. 

Sweating feet; Nos. 31, 37. 

Tonsillitis; Nos. 1, to throat; 12. 

Ulcers ; dress with No. 1 , and wash with 
suds of No. 33. 

Varicocele; Nos. 16, 17, 18. 

Vertigo, dizziness; Nos. 3, 4, 11. 

Vomiting; No. 11. No. 1 to stomach. 

White swelling; No. 1, and tight ban- 
daging. 

Whooping cough; No. 12, and tea of 
red clover blossoms. 

Wounds', No. 1, plastered on lint. 



i 230 ADVERTISEMENTS. 



FACIAL BLEMISHES. 

Besides the disfigurements caused by various skin diseases, already sufficiently 
described in Chapter X. there are several minor ones, hardly belonging among 
diseases, and yet a source of much annoyance. Some are birth-marks, ncevi, 
which can only be removed by operation. Some are scars, from accidents, which 
can seldom be removed. Some are like freckles, peculiar to the skin, and hardly 
removable. But many blemishes are mere superficial growths, warts or moles. 
that can be readily and safely eaten off by mild caustics persistently applied. 
•• Liver spofs " and other local stains, can be removed by lotions that bleach th« 
skin without harm; but these and more general stains that constitute a "bad 
complexion " are often indications that there is need of general treatment to 
purify the blood and secretions. 

Hair may grow where it ought not to — " superfluous " — and may fall out where 
it is wanted— baldness. These complaints are often dependent upon general faults 
of nutrition, deserving of attention, and yet the immediate and most practical 
treatment for many cases is local. Recognizing the desire for self-improvement in 
this direction as commendable. Dr. Foote has sought the safest and most legiti- 
mate methods of relief for these personal defects, and offers the following list ox 

Safe Sanitary Skin and Toilet Articles. 



No. 31. BoracicSoap, 



To improve complexion, relieve itching, and minor eruptions, red spots, scales 
and dandruff (a fine shampoo), 50 cents per cake, mailed. For every-day use. 

No. 32. Ichthyol Soap, 

For saltrheum, ringworm, un atural redness of nose or face, "skin worms,"' 
blackheads, pimples. 50 cents, by mail. 

No. 33. Anti-Parasitic Soap, 

Banishes all superficial parasites, animal and vegetable; fleas, ringworm, itch 
insects, lice, "crabs," and is useful against unclean eruptions (syphilitic), ulcers, 
etc. 50 cents, by mail. 

No. 34. Sanitary Caustic, 

Will gradually eat away warts, moles, and other excrescences without excit- 
ing inflammation or leaving scars. 50 cents, by mail. 

No, 35. Sanitary Emulsion, 

A moth and freckle lotion, to clear the complexion, which it does by erasing 
the color-patches, brown stains and deposits left by blood impurities, liver torpor, 
etc. It thoroughly cleanses the pores, dissolves hardened secretions, and in short 
helps " off with the old and on with the new " cuticle. 50 cents, by mail. 

No. 36. Depilatory— A True Hair Eradicator. 

.Removes superfluous hair, without any caustic effect, thus avoiding the in- 
jurious effect of the ordinary chemical depilatories. $1.00 per box, by mail. , 

Nn 1 For threatened Baldness, poor growth of hair, and all scalp 
liU. I. irritations, we offer our regular Magnetic Ointment (No. 1) as the best 
remedy, and can show the finest testimonials to its usefulness in this line. 25c, 
50c, $1.00; by mail; (seepage 727). Order Dr. Foote's No. 1 Hair Pomade, 50 cents. 

No. 37. Sanitary Powder, 

Just the thing for sore feet, moist, itchy skin surfaces, chafing, etc. Handy 
for ladies 1 and babies 1 toilet; also for barbers, big and little shavers. Relieves ten- 
der feet, moist arm-pits and manv forms of skin disease needing a drying, disin- 
fecting, soothing and real sanitary influence. Dispels disagreeable odors of the 
body; substitutes better odor. 2o cents, by mail. 

SANITARY BUREAU, 129 East 28th St., New York, 



The Best 

Yel 




A Family Medical 

- Marriage Guide 

NEW, THOROUGH, PRACTICAL and UP-TO-DATE 

This Great Work — Dr. Foote's Latest and Best 

Embraces all the popular, useful, and original matter of his earlier writings 

nEDICAL COMMON SENSE and PLAIN HOME TALK 

which, being entirely revised, enlarged, and reset in new type, now appears in one 

Handsome Cloth-bound Volume of 1248 pages, 
Embellished with over 400 illustrations, 
Including 18 full-page color plates, with 80 pictures, 
And a Chapter of 250 Prescriptions. 
Popular Edition, $2. Standard Edition, $3 ; in Leather, $4. 

Murray Hill Pub Co., 129 East 28th Street, New York, 



CONTENTS. 



THE READER IS RECOMMENDED TO CONSULT FREELY THE INDEX AT 

THB END OF THE BOOK, WHICH HAS BEEN SO PREPARED 

THAT HE CAN FIND ALMOST ANY SUBJECT 

HE MAY BE IN SEARCH OF. 



PART I. 



DISEASE: ITS CAUSES, PREVENTION 

AND CURE. 



OPENING CHAPTER. 

PAGE 

Disease and Its Causes 15 

The Causes of Disease, 16 ; Nervous Telegraphy, 18 ; Mental Disturbances, 
20 ; Blood Derangements, 23 ; The Germ Theory, 26 ; A Prophetic Article, 
27 ; Germs of Malaria, 31 ; Cheese and Butter-making Germs, etc., 32 ; Are 
Germs Producers or simply Bearers of Disease? 34. 

CHAPTER II. 

The Causes op Nervous Derangements and Affections of the Blood 87 

Ignorance, 37 ; Real Ignorance, 39 ; Air Brakes on the Car of Knowledge, 
42 ; False Modesty Leads to Hygienic Error, 42 ; Violating the Moral 
Nature, 44 : How it was viewed by a Noted Preacher, 46 ; No Great Names 
on Fences. 48 ; The Food We Eat, 51 ; The Pork Parasite Causes Interna- 
tional Controversy, 57 ; A Hog would become Diseased by Eating Man, 59 ; 
Hog and Hominy in Old Kentuck, 60 ; Plenty of More Wholesome Food, 
62 ; Facts Regarding Vegetable Diet, 65 ; How the Killing is Done, 70 : 
Cannibalism Within the Human Body, 72 ; Food for the Fat and Food for 
the Lean, 73 ; A Brief Word to the Lean, 75 ; Beware of Fads, 76 ; Good 
Digestion the Main Thing, 82 ; A Few Danger Signals, 82 ; Winged Scaven- 
gers, 84 ; The Liquids We Drink, 93 ; Tea and Coffee, 95 ; How Tea Should 
be Prepared, 97 ; English Chicory, 98 ; Alcoholic Drinks, 99 ; Doctors Disa- 
gree, 101 ; Uses and Abuses of Alcohol, 104 ; Drunkards are not Properly 
Treated, 106 ; Milk is the First Fluid. 107 ; An Ideal Stable for Cows, 108 ; 
How to Purify Milk, 111 ; Milk Should not be Boiled, 114 ; Reliable Milk is 
Coming, 115 ; Kumyss. Buttermilk, etc., 117 ; Nature's Beverage— Water, 
119; Precautions to be Taken, 120; A Noted Writer in Error, 124; The 
True Value of Water, 126 ; The Atmosphere We Live In, 129 ; Electrical 
Radiation, 132 ; Erroneous Philosophy Corrected, 135 ; Proper Management 
in Cold Weather, 138 ; Importance of Careful Ventilation, 139 ; Our Meth- 
ods of Heating, 141 ; The Clothes we Wear, 146 ; Not Robust Enough for 
Bloomers, 149 ; Low-Neck Dresses, 153 ; About the Costumes of Men, 155 ; 
Knit Suits, Rubber Garments, and Footgear, 155 ; Second-hand Clothing 
and Shoddy, 159 ; Bad Habits of Children and Youth. 160 ; Bad Habits at 
School, 162 ; Going " Barefoot," 164 ; Sleeping with Elder Persons, 165 ; A 

6 



CONTENTS. v ii 

Destructive Habit, 167; Standing on the Head, 170; The Cigarette Habit, 
170; Bad Habits of Manhood and Womanhood, 173; Poisonous Properties 
of Tobacco, 175; Health Hints to Smokers, 179; Intemperance in the use 
of Ardent Spirits, 180; Bad Habits in Dress, 181; A Natural Waist, 182; 
The Drug Habit, 186; Human Night-Hawking, 189; Fast Eating, 191; Big 
Dinners, 193; Social Magnetism versus Sexual Isolation, 195; Where the 
Effects of Isolation may be Seen, 198; What Happens in Cities, 200; The 
Secret of Sexual Attraction, 204; Prostitution, 205; How it Affects the 
Innocent, 208; State Regulation of Prostitution, 212; Some of the Avoid- 
able Causes of Prostitution, 218; Unhappy Marriage, 225; Impure Vacci- 
nation, 228; Adulterated Medicines, 233; Adulterations of Mineral Medi- 
cines, 235; Brutality and Inhumanity, 236; Man's Inhumanity to Man, 237; 
The Death-Penalty Must Go, 239; Medical Societies Oppose the Death- 
Penalty. 241; Is the Death-Penalty a Deterrent? 243; Wealth, 246; Failures 
in Business, 249; Excessive Study, 251; Excessive Labor, 252; Worry, 254; 
Melancholy, 257. 

CHAPTER III. 

Prevention op Disease • 259 

How to Have Healthy Babies, 262; Hints to Parents in Average Health, 
264; The Secretions are Affected by Mental Conditions, 265; Advice to the 
Pregnant, 265; Some General Hints, 267; How to Preserve the Health of 
Children, 268; Their Little Legs Need Clothing, 270; How Babies Should be 
Fed, 272; Bathing, Exercising, Dosing, etc., 273; The Education of an 
Infant, 276; " Don'ts " for the Nursery. 276; Dietetics for Old and Young, 
277; The Physiological Instruction of Children, 281; Mental and Physical 
Recreation, 282; Bicycle Exercise, 290; " Shut Your Mouth," 294; Sleep, 
295; Cleanliness, 298; Pure Air, 300; Sunshine, 302; Good Temper, 306; 
Keep the Feet Warm, 307; Other Suggestions, 311. 

CHAPTER IV. 

Common-Sense Remedies 312 

Vegetable Medicines, 313; Medicine in Ye Olden Time, 316; The Self -Cure 
of Animals, 320; Revolution in the Practice of Medicine, 321 ; Will Vege- 
table Medicines Drive out Microbes? 323; Psychic Medicine, Christian 
Science, Mental Science, etc., etc., 323; Humor Superstitions, 327; Thera- 
peutic Electricity, 329; Are not Nerve-Force and Electricity the Same? 
332; The Therapeutic Value of Electricity, 335; Electricity, to be Effect- 
ual, Must be Properly Applied, 337; Animal Magnetism, 343; The Begin- 
ning of Mesmerism. 344; More Recent Investigations, 345; How are these 
Mesmeric Cures Effected? 347; Water, 352; Medicated Inhalation, 356; 
Conclusion, 357. 

CHAPTER V. 

Doctors 358 

Doctors "Jacks at all Trades," 361; Should we have Women Doctors? 
363; Rapacious Doctors, 367; Doctors who Bank on the Reputations of 
Others, 371; More Pretenders, 374. 



PART II. 



CHRONIC DISEASES; THEIR CAUSES AND SUCCESSFUL TREATMENT, 
WITH A CLOSING CHAPTER 

CONTAINING NUMEROUS PRESCRIPTIONS FOR COMMON AILMENTS, ANTIDOTES FOR 
POISONS, VALUABLE SUGGESTIONS FOR EMERGENCIES, ETC. 

OPENING CHAPTER. 

PAGE 

Chronic Diseases .-.'• . : 377 

What is a Chronic Disease? 380; Various Kinds and Signs of Chronic 
Disease, 383; The Personal Equation, 3S7; Functional and Organic, 380. 



viii CONTENTS. 

CHAPTER II. 

PASS 

Chronic Diseases op the Breathing Organs 892 

Chronic Catarrh of the Head, 395; Influenza-Catarrhs, 400; Hay Fever, 402; 
Nasal Polypi, 403: Chronic Affections of the Throat. 403: Chronic Bron- 
chitis, 408; Asthma, 411; Consumption. 413; Koch's Bacilli, 414: "Is Con- 
sumption Hereditary ? rt 416; The Curability of Consumption, 420: Treat- 
ment of Chronic Diseases of the Breathing Organs. 421; Koch's Serum and 
other "Remedies, 423; Climatic Influences Considered, 426; Artificial Infla- 
tion of the Lungs. 428: Deep-Breathing and Chest Exercise, 428; Living 
with One Lung, 433; The Main Thing to Affect a Cure, 435. 

CHAPTER III. 

Diseases of the Heart and Blood-Vessels 436 

Palpitation of the Heart. 440; The Tobacco Heart, 442; Angina Pectoris, 
443; Diseases of Blood-Vessels, 444; Aneurism, 445; Apoplexy, 447; Vari- 
cose Veins, 448. 

CHAPTER IV. 

Chronic Diseases or the Liver, Stomach, and Bowels 449 

Chronic Affections of the Liver, 451 ; Where Torpid Livers are Found, 452; 
Why the Negro is more Enduring in the Tropics, 453; Liver-Torpor Com- 
mon in New Countries, 454: Other Diseases may Result from Neglect of 
the Liver, 457; Bilious Headache, 459; Gall-Stones, 461; Dyspepsia. 463; 
The Horrors of Dyspepsia, 466; Importance of Salivary Digestion. 467; 
Intestinal Indigestion, 469: Good and Bad Ferments, 471: Suggestions for 
Treatment, 472; Aids to Digestion, 473; Constipation. 477: The Treatment 
of Constipation, 481: Injections and Purgatives, 485; Spring Disorders and 
Loss of Appetite, 486: Chronic Diarrhoea. 488: Hemorrhoids, or Piles, 490; 
Falling: of the Rectum, 495; Stricture of the Rectum, 495: Fistula-in-Ano, 
496; Fissure of the Anus, 497; Intestinal Parasites, 498; Hernia, or Rupture, 
500; Inconvenience and Danger of, 504. 

CHAPTER V. 

Chronic Affections of the Urinary Organs 506 

Diseases of the Kidneys, 508; Bright 's Disease, 508; Bicycles and Bright's 
Disease, 513; The Curability of Bright's Disease, 513: Further on the 
Hygiene of Bright's Disease, 516; Medical Treatment of Bright's Disease, 
517; Kidney Colic, or Gravel, 518; Cystitis, 518; Enlarged Prostate. 520; 
Incontinence of Urine, etc., 520; Urethritis, Gonorrhoea, Gleet, Stricture, 
522; Treatment for Such Cases, 526. 

CHAPTER VI. 

Private Words for Women ► 530 

Concerning Causes of Uterine Diseases, 534; Contagious Venereal Dis- 
eases, 540; Diseases Resulting from Child-Bearing and Abortion, 540; 
Derangements of the Monthly Flow, 543; Irregular and Painful Menstrua- 
tion, 545: Suppressed Menstruation, 547; Leucorrhcea, 548; Falling of the 
Womb, 557; Ulceration of the Womb, 564; Polypus of the Womb, 564; 
Dropsv of the Womb, 565: Chronic Inflammation of the Womb, 566; 
Vaginal Affections, 566; Nymphomania. 567; Amorous Dreams, 569; 
Anthropophobia and Sexual Apathy, 571; Sexual Dyspepsia, 571; Ovarian 
Diseases, 573; Treatment of Diseases of Women, 573. 

CHAPTER VII. 

Hints to the Childless 576 

The Causes of Barrenness, 581 ; Local Inadaptation, 581 ; Diseased Condition 
of the Wife, 588; More Interesting Facts About the Ovaries. 593; Are the 
Ovaries Essential for the Maintenance of Sexual Desire? 595; Diseased 
Condition of the Husband, 596: Excessive Amativeness, 599; Tempera- 
mental Inadaptation, 601; How to Promote Child-bearing, 604; Importance 
of Overcoming Local Inadaptation, 607; More Valuable Hints for Over- 
coming Barrenness, 609: When Disease is the Cause of Sterility, 610: When 
Unfruitfulness is Caused by Temperamental Inadaptation, 613; A Word to 
Jealous Husbands, 613. 



CONTENTS ix 

CHAPTER VIII. 

PAGE 

Private Words fob Men 616 

The Penis and its Diseases, 61?; Phimosis, 622; The Scrotum and its Dis- 
eases, 625; The Testicles and their Diseases, 625; Enlargements of the 
Testicular Glands, 629; Hydrocele, 630; Varicocele, 630: Seminal Weak- 
ness, 632; My Views Endorsed, 636; Two Kinds of Spermatorrhoea, 638; 
Complicated Spermatorrhoea, 639; The Treatment of Spermatorrhoea, 643; 
Inflammation of the Prostate Gland and Seminal Vesicles, 644; Satyriasis, 
646; Sexual Perverts and Degenerates. 649; ' k As the Twig is Bent, the 
Tree Inclines." 650; Dangers of School-Life, 651; Other Sources of Con- 
tamination, 652. 

CHAPTER IX. 

Impotenct 655 

May Affect Either Sex, 657; Mental as Well as Physical Causes, 659; Imag- 
inary Impotency, 662; Physical Causes, 663. 

CHAPTER X. 

Affections of the Nerves, Blood, and Skin ..,,.....,..,... 668 

Affections of the Nerves, 669; Neurasthenia, 671; Burning the Candle at 
Both Ends, 672; Hypochondria, 674; Hysteria, 674; Treatment of Neuras- 
thenia, Hypochondria, and Hysteria, 675; Paralytic Affections, 679; Facial 
Paralysis, 680; Shaking Palsy, 681; Locomotor Ataxy, 681; Epilepsy, 681; 
The Question of Functional or Organic Disease, 684; Scrofula, 687; Symp- 
toms and Treatment of Scrofula, 689; Aches and Pains, 691; Nervous 
Headaches, 692; Congestive Headache, 693; Neuralgia, 694; The Treat- 
ment of Neuralgia, 696; Rheumatism, 697; Treatment of Rheumatism, 698; 
Gout, 700; The Treatment of Gout, 700; Cancer, 701; The Treatment of 
Cancer, 703; Syphilis, 705; Its Progress, 707; Its Treatment, 709; Skin Dis- 
eases, 710; The Main Affections Described, 711; The Causes, 712; Urticaria 
— Hives, 713; Rosacea, 713; Pruritus— Itching, 714; Herpes, 714; Eczema- 
Salt Rheum, 715; Other Scaly Skin Diseases, 716; Comedones, Black-heads, 
Worms, 717; Acne, 718; Boils — Carbuncles, 718; Parasitic Skin Diseases, 
719; Pediculi— Lice, 720; Tinea Trichophytina— Ringworm, 720; Tine?. 
Versicolor— Pityriasis, 721 ; How to Cultivate Beauty of Face, 721 ; Health 
the Basis of Beauty, 724; Face Recipes, 727; Baldness, 727. 

CHAPTER XI. 

Affections of the Eyes and Ears 780 

Nature's Photographic Camera, 730; How Old Eyes can be Restored, 734; 
Near-sight or Myopia, 736; Other Optical Defects, 737; Diseases of the 
Eyes, 738; Chronic Sore Eyes, 740; Cross Eyes, 743; Other Diseases of the 
Eye, 744; Defective Hearing, 744. 

CHAPTER XII. 

Treatment of Disease 751 

Everybody His Own Doctor, 752: Dietetics, 756; Clear Conscience Better 
than a Petted Stomach, 757; Warranting Cures, 759; To Consultants, 760; 
List of Questions, 761 ; Evidences of the Curability of Chronic Diseases, 
763; Affidavits of the Drs. Foote, 765; Cases of Diseases of the Breathing 
Organs, 766; Cases of Diseases of the Digestive Organs, 767; Cases of Ner- 
vous Diseases, 768; Cases of Diseases of the Urinary Organs, 769; Another 
Case of Brighfs Disease, 770; Cases of Diseases ot Men, 770; Cases of Dis- 
eases of Women, 773; Cases of Barrenness, 775; Born by the Book, 775; 
Miscellaneous Diseases, 777: Earlier Triumphs, 779; A Bedridden Case, 
779; Concluding Remarks, 781. 

CHAPTER XIII. 

Two Hundred and Fifty Prescriptions for Common Ailments and 
Suggestions for Emergencies. 

Preliminary Remarks 782 

Antidotes for Poisons, 799: Rules for Resuscitating the Drowned, 801 : 
What to do When the Patient Begins to Breathe, 804; The Care of Babies. 
■ 804. 



CONTENTS. 

PART III. 



PLAIN TALK ABOUT THE SEXUAL ORGANS; THE NATURAL RELA- 
TIONS OF THE SEXES: CIVILIZATION, SOCIETY, 
AND MARRIAGE. 



OPENING CHAPTER. 

PAGE. 

Introductory Words 807 

CHAPTER II. 

The Sexual Organs ,. 810 

The Cause of Their Disgrace, 810; Facts Regarding Pagan Worship, 811; 
Their Influence on Physical Development, 814; Their Influence on Health. 
818; Every Faculty and Organ Necessary, 821; How They are Made Instru- 
ments of Conjugal Association. 825; Individual Electricity, 826; Chemical 
Electricity. 831; Frictional Electricity, 833; How They are Made Instru- 
mental in Perpetuating the Race. 834; The Physiology of Reproduction, 
838; Their Influence on the Social Position of Woman, 840; The Real 
Causes of Rome's Fall, 842; Their Influence on Civilization, 846 ; Polyandry 
and Prostitution, 848. 

CHAPTER III. 

History or Marriage. 852 

History of Polygamy, 853; Hebraic Polygamy, 856; Grecian Concubinage, 
859; Persian and Mohammedan Polygamy, 862: Polygamy in the New 
World, 865; History of Mormon Polygamy, 866; Why not let Woman Suf- 
frage Settle the Problem? 874; History of Monogamy. 880; Marriage 
Became a Passing Union, 884; Marriage "Among the Northern Barbarians, 
886; How Marriage in the Old Empire Flourished. 887; Marriage in Ancient 
Scandinavia, 893; History of Complex Marriage, 894; The Children of the 
Community. 897; What a Physician saw at the Oneida Community, 899: 
The Basic Principles of the Oneida Community, 901; Was Mr. Noyes' 
Dream Realized? 905; Historical Chips, 909. 

CHAPTER IV. 

Marriage as it is in Barbarism and Civilization 921 

Marriage in the Old World, 921; Marriage in the New World, 966; Con- 
cluding Remarks, 990. 

CHAPTER V. 

Defects in Marriage Systems 992 

Demerits of Polygamy, 997; Demerits of Monogamy, 998: Demerits of 
" Complex Marriage," 1009. 

CHAPTER VI. 

The Remedy. A Chapter full of 1012 

Original and Startling Suggestions for Twentieth Century Readers. 

CHAPTER VII. 

Sexual, Immorality 1024 

The Causes, 1025; The Cure 1028. 

CHAPTER VIII. 

Conclusion op Part Third.......... 1084 



CONTENTS. ZJ 

PART IV. 

SUGGESTIONS FOR IMPROVEMENT OF MONOGAMIC MARRIAGE, ETC. 



OPENING CHAPTER. 

Prefatory 1041 

CHAPTER It. 

Adaptation in Marriage : 1045 

What is Mental Adaptation? 1050; What is Physical Adaptation? 1053; 
First, the Vital Temperaments, 1056; Second, the Non- Vital Tempera- 
ments, 1059; The Mixture of Two Temperaments, 1064; The Mixture of 
Three Temperaments, 1067; The Mixture of Four Temperaments, 1069; 
Dr. Powell's Six Rules, 1078. 

CHAPTER III. 

Restricted Marriage and Parentage 1081 

Restricted Parentage, 1082; A Practical and Constitutional Plan, 1090; 
Divorce, 1095. 

CHAPTER IV. 

Three Phases op Monogamic Marriage Photographed 1100 

Mental Marriages, 1101 ; Physical Marriages, 1103; Wretched Misfits, 1104. 

CHAPTER V. 

Philosophy op Elopements 1111 

CHAPTER VI. 

Intermarriage op Relatives 1117 

CHAPTER VII. 

Essays for Married People 1121 

The Wife the Equal Partner, 1123; Sleeping Apart, 1127; Sexual Modera- 
tion, 1130; Jealousy, 1134; "Conjugal Prudence," 1136; Contraceptics; 
Their Value in Promoting Human Evolution, 1143; Sexual Indifference, 
1148; Signs, Symptoms, and Discomforts of Pregnancy, 1153; Food for 
Pregnant Women, 1155; Card to Married People, 1156. 

CHAPTER VIII. 

What Determines Sex? 1158 

Professor Schenk's Theory, 1159; Many Other Theories, 1161. 

CHAPTER IX. 

Philosophy op Child-Marking 1164 

The Phenomena of Child-Marking Explained, 1168; Why Offspring Resemble 
Both Parents, 1168; Why they Resemble One Parent, 1171; Why they Resem- 
ble Neighbors, 1171 ; Why Children by Second Husbands Resemble the 
First, 1174; How Frights Mark a Child, 1175; Child-Marking and its Influence 
on Human Evolution, 1177. 

CHAPTER X. 

Essays for the Future on Marriage and Parentage 1178 

Early Marriage, 1179; What is a Marriageable Age? 1180; Advantages of 
Early Marriage, 1182; Children's Marriages, 1183; Woman's Varied Avoca- 
tions, 1187; Prepare the Young for Early Marriage, 1191; Prepare for Parent- 
age, 1195; Card to the Unmarried, 1197. 

Index >.. 1198 

Advertisements 18K 



miiasTRHTPions. 



FIGURE PAGE 

1 Capitol of the Nervous System 16 

2 Professor Brain's Telegraph . . 20 

3 The Heart and Arteries 22 

4 Diagram of Blood Circulation 23 

5 Capitol of the Vascular System 24 

6 A Frog's Foot 25 

7 Bacteria 28 

^ Laveran's Germs of Malaria. . 32 

9 White and Red Corpuscles 36 

10 Trying to Lift Himself 37 

11 The Creature of Accident 39 

12 Mother Grundy Blindfolds the 

Mothers of the Race, and 

the Children too 41 

13 A Man who has nearly Worn 

Himself out in the Service 

of the Devil 45 

14 One who has Gained not only 

Avoirdupois, but Intelli- 
gence and Goodness 46 

15 "The Reverse. Behold the 

Contrast " 47 

16 Goddess of Justice 50 

17 " Plying Knife and Fork .52 

18 An International Provision 

Store 53 

19 The Use of Swine 55 

20 Trichinae, Cysts and Meat 58 

21 Encvsted Trichinae in Muscle. 59 

22 The'Unhealthv Pair 60 

23 Infected Muscle 61 

24 Sheep— Wholesome to the Eye 63 

25 The Vegetarian Bicyclist.. . .*. . 66 
2ti The Vegetarian Pedestrian ... 67 

27 Vegetable Food 69 

28 The Animals we Slaughter ... 71 

29 Somewhat Weighty 74 

30 Thin ! Too Thin ! 75 

31 A Public Dining Room 78 

32 A Little Death- Trap 83 

33 The House Fly 85 

34 The House Fly's Foot Plas- 

ters Microbes on our Faces 86 

35 Common Field Mushroom- 

Edible 89 

36 The Liquids we Drink 94 

37 Tea Plant 97 

38 The Man who Drinks Modern 

Liquors 100 

39 The Temperate Man 102 

40 The Autumn of a Temperate 

Life 102 

41 Teeth of a Grazing Cow 109 

42 Teeth of a Stall-fed Cow 109 

43 A Familiar Scene on the Farm 111 

44 First-class Palace for the Kine 116 

45 The Old Oaken Bucket 120 



FiGr 
46 
47 
48 
49 

50 

51 

52" 

53 

54 

55 



56 

57 

58 
59 
60 
61 
62 
63 
64 
65 
66 
67 
68 
69 
70 
71 
72 
73 
74 



To 

76 



79 
80 
81 
82 
83 
84 
85 
86 



89 
90 

91 
92 
93 
94 
95 



xu 



RE PAGE 

Nature's Beverage on a Frolic 121 

Some Denizens of Pond 126 

Our Planet and its Atmosphere 129 
Electricity of the Thunder 

Storm 131 

Electrical Radiation 133 

Sweat Glands 135 

Old-fashioned Fire-place 142 

How we come into the World. 146 
Loose-fitting Garments of Japs 148 
Amelia Bloomer in her Orig- 
inal Costume of 1851, Con- 
trasted with 1899 152 

The Costumes of L T ncle Sam's 

Numerous Family 156 

Various Inventions for the 

Feet 158 

Little Barefooted Candy-eater 161 

Bad Position in Sitting 163 

Smoking and Snuffing 173 

First Lesson in Smoking 174 

Defective Sticks 179 

Positions of the Diaphragm . . 181 

A Contracted Waist 183 

A Natural Waist 183 

Fragment of Ancient Venus . . 184 

The Salivary Glands 192 

These are fit for a Feast 194 

The Isolated Girl 196 

Social Magnetism 200 

Innocent Girl Changed bv Vice 206 

Night Scene in "Suicide Hall" 207 

Reward Offered for Vice 218 

Want and Threatened Starva- 
tion Held out to Virtue 219 

Unhappy Marriage 226 

Jenner Vaccinating his Child. 229 

The Hand that does it 233 

An Illustration 236 

General N. M. Curtis 240 

The Electrocuting Chair 244 

Horn of Plenty 247 

Othello's Occupation Gone 249 

The Student at his Books 252 

The Overworked Man 253 

A Worrving Woman. 254 

The Melancholy Man 257 

A Cure for Melancholy 258 

A Cluster of Babies 266 

Triumphant Baby and Mother 270 
Editor's Plan for Diverting the 

Babv .... 275 

A Healthy Mother and Child. . 278 

Magnetic Exercise 283 

Coming Ladies on Horseback 285 

The Swimmer 288 

A Group of Cyclers 291 



illustrations: 



Xlll 



FIGURE PAGE 

96 All Asleep 296 

97 Perspiratory Gland and Tube. 298 

98 This is how an Enclosed Ver- 

anda Looks on the Outside.. 304 

99 Warming Feet Magnetically.. 310 

100 A Specimen of what Nature 

Produces in her Laboratory. 314 

101 Botanic Doctor of Ye Olden 

Time 317 

102 Nature's Laboratory— Good 

Food and Medicine 320 

103 One Corner of Dr. Foote's Lab- 

oratory >. 322 

104 Mrs. Eddy, Founder of Chris- 

tian Science 325 

105 Viewing the Moon over the 

Right Shoulder 327 

106 Electrical Radiation from the 

Hand 329 

107 Repellant Electric Waves of 

the Hand 331 

108 Ordinary Electro-magnetic 

Machine 336 

109 Dr. Footed Office Battery 340 

110 Magnetic Hands 342 

111 Putting a Sensitive Subject to 

Sleep 346 

112 Nerve Atmosphere 347 

113 Japanese Manipulators 350 

114 Japanese Manipulators 351 

115 Priessnitz's Medicine 353 

116 The "Doctor" in the Bow.... 359 

117 The Terrified Lady 368 

118 The Abdominal Cavity Laid 

Open 376 

119 Dr. Foote's Offices since 1867. . 381 

121 Bow-legged but Healthy 384 

122 Seems Nervous 385 

123 The Octopus of Evil Habits 

and Victims of "High Life " 389 

124 Diagrammatic Lung and 

Structure 393 

125 Respiratory System of a Tree. 394 

126 Respiratory System of Man. . . 395 

127 The Cavities in the Bones of 

the Face Subject to Catarrh 396 

128 Nostrils as Seen from Behind. 399 

129 Polypus Tumor 401 

130 The Diseased Throat 403 

131 Nasal and Throat Air-passages 405 

132 Laryngoscope 406 

133 Vocal Cords 407 

134 Wind Pipe or Bronchus and 

Tubes 409 

135 Typical Case of Consumption 414 

136 Fungi, or the Bacilli of Con- 

sumption 415 

137 Taking in Tubercle Germs 416 

138 The Air Sacs of the Lungs.... 418 

139 The Out-door Cure 424 

140 Getting Fresh Air 4:25 

141 Chest Exercises 431 

142 Chest Exercises 431 

143 Lungs and Heart 432 

144 The Heart 437 

145 Enlarging his Heart 4S8 

146 The Normal Heart 441 

147 Heart in Valvular Disease 441 

148 Disease of a Coronary Artery 441 

149 Various Forms of Aneurisms. 4 4(3 

150 Varicose Veins of the Leg 4 18 

151 Digestive Machinery 4-0 



FIGURE PAGE 

152 The Ethiopian. 454 

153 The Caucasian 455 

154 The Under Side of the Liver. . 456 

155 Bilious Headache 460 

156 Nerves of the Stomach 465 

157 The Pancreas 471 

158 Stomach Washing 474 

159 Stomach Washing 475 

160 Dr. Tanner 476 

161 Showing how the Male Organs 

are Affected by Constipation 478 

162 Showing how Female Organs 

are Affected by Constipation 479 

163 A Delicious-Looking Medicine 482 

164 The Danse du Ventre 484 

165 Tumorous and Varicose Piles. 491 

166 Rectum laid open with Piles.. 494 

167 Complete Fistula-in-Ano 497 

168 Surgical Examination 497 

169 Magnified Head of Tapeworm 499 

170 Where Hernias Occur 502 

171-176 Progressive Hernia 503 

176A Operation for Relief of Stran- 
gulated Hernia 505 

177 The Human Water Works. ... 507 

178 The Kidney Cut Through 509 

179 Kidney Casts 510 

180 Smooth— B 1 a d d e r Stones- 

Rough 519 

1^1 A Soft Catheter 521 

182 Leucorrhceal Matter 523 

183 Gonorrhoea 1 Matter 523 

184 Strictures of the Urethra 527 

185 Urinary Fistula Resulting 

from Stricture following 

Gonorrhoea 529 

186 Organs of Woman (Diagram- 

matic) 532 

187 Another Sketch True to Life. 533 

188 Composite Photograph 535 

189 Room for Vital Organs 536 

190 Vital Organs, Crowded 537 

191 Wrong Position 538 

192 Right Position 538 

193 A Mis-shapen Form 539 

194 Female Organs Exposed 554 

195 Family Syringe 557 

196 Vaginal Syringe 557 

197 Womb Falling Forward on 

Bladder 558 

198 Womb Falling Backward on 

Rectum 559 

199 Procidentia 560 

200 Some of the Pessaries in Use.. 562 

201 Dr. Pott's Spring-stem Pessary 564 

202 Abdominal Supporter 565 

203 Woman as Formed by Nature 572 

204 Woman as Deformed bv 

Fashion 573 

205 A Plain Home Talk Baby 578 

206 A Plain Home Talk Baby 580 

207 Local Inadaptation 582 

208 Local Inad apt ation : 583 

209 Diseased Ovary 590 

210 The Ovary in Health 591 

21 1 The Ovary in Old Age 592 

212 The Spermatozoa 598 

213 Temperamental Inadaptation 600 

214 Temperamental Inadaptation 601 
215-217 Dr. Pallen's Operation on 

the Cervix 607 

218 The Prize Microscope 611 



X1T 



ILLUSTRATIONS. 



pi©. 



219 A Plain Home Talk Baby 514 j 

220 Vertical. Section of Male Or- 

gans . . . : 51 ; 

281 Chancre 619 

223 Side-view of Male Organs 62 

224 Structure of the Testicle 626 

225 Male Organs 627 i 

226 French Method of Ligating 

Varicocele 331 I 

227 The Testes in Health and Dis- 

ease 632 

228 Spermatozoa, etc 640 

229 The Prostate and Seminal 

Vehicles 64o 

229A Rev. Rudolph' Foith '.'.'.WW'.'.'. 652 

229B Oscar Wilde 653 

230 Womb. Ovaries. Fallopian 

Tubes, etc 657 

231 Front View of Penis 661 

232 Cause of Impotency found 665 

233 Neuron and Nerve-Bulbs 669 

234 Neuron 685 

235 A Case of Hemiatrophy 686 

236 Charles Sprague, the Living 

Skeleton 68T 

237 Facial Nerves 694 

238 Rheumatism 697 

239 A Nest of Cancer Cells 703 

240 Gummy Tumors 708 

241 A Magnified Cross -cut of Skin 711 

242 Demodex Magnified 200 Times 71* 

243 Burrow. Itch-mite, and Eggs. . 713 

244 Pediculus Pubis J21 

245 Fair and Spotless 722 

246 Nose made from Forehead.... 723 

247 Nose made from the Arm 724 

248 Jo-Jo the Dog-faced Boy 725 

249 Horn on Forehead 726 

250 Hair in its Follicle 728 

251 Hairv Na? vus 720 

252 Vertical Section of the Eve ... 731 

253 An Eye with Proper Convexity 732 

254 Too Great Convexitv 733 

255 Cornea too Flat 734 

256 Application of Fingers for 

Near-sight 736 

257 Examining with Ophthalmo- 

scope 739 

258 Mechanism of the Eve 741 

259 Cross Eves 743 

260 The Human Ear 746 

261 Rescuing the Drowned 802 

262 Rescuing the Drowned 803 

262A Civilization of To-dav 866 

263 The Seed of the Oak and of 

the Plum-tree 814 

264 Is it Charlie or is it Mary ? 815 

265 The Female Venus de Medici; 

The Male Apollo Belvedere. 819 

266 The late Henry Ward Beecher 822 

267 A Magnetized Cane Dance — 828 

268 John Randolph 831 

269 Spermatozoon 836 

270 Some New American Citizens. 843 
270A Mrs. Frances A. Lee 851 

271 The Polvgamic Farnilv 855 

272 Joseph Smith the Prophet 868 

273 Brigham Young 869 

274 Part of President Lorenzo 

Snow's Farnilv 871 

275 A Utah State Senator 875 



PAGE. FIG. PAGE. 

276 The Sultan of Sum 876 

2>t A Glimpse of Salt Lake City 

— Wahsatch Mountains 878 

27S The Monogamic Family 881 

279 GrouD of Oneida Communists. 896 

280 First Child born in the Com- 
munitv 898 

281 A Stirpicultural Youth 899 

2*2 The late Rev. J. H. Noyes .... 903 

283 Oneida Communitv Mansion.. 907 

284 Historical Chips...* 910 

285 Chinese Marriage 924 

286 Japanese Official and Farnilv.. 926 

287 Japanese Girl 928 

288 Persian Lady 937 

289 Mrs. Abdul Hamid Le Mesur- 
rier. . . 539 

29C Zulu Doctor.. '.'.'.'.'.'.'.'.'.WW WWW. 945 

291 Wife of Oom Paul 946 

292 English Girl 948 

293 Victoria in the Prime of Life.. 951 

294 A French-Actress 954 

295 A Finnish Woman 960 

296 A Turkish Ladv 964 

297 A Male Eskimo" 968 

298 A Female Eskimo 969 

299 A Greenlander 970 

30G Fruits of Uncongenial Mar- 
riage 978 

301 The Late Princess of Hawaii . 980 

302 A Ladv of Porto Rico 982 

303 A Mestizo Girl 989 

304 Jesus and the Accused Woman 994 

305 First Five Years of Marriage . 1006 

306 Five Years Later 1006 

306A Enmeshed in Cupids Bonds 1011 

307 Clothes of One Size and Pat- 
tern for the Million 102C 

308 Affectionate Husband and 
Wife i027 

309 A Typical Libertine. 1032 

310 Mental Organization 1051 

311 Sanguine Temperament 1054 

312 Bilious Temperament 1055 

313 Profile of the Nose 1056 

314 Lymphatic Temperament 1058 

315 Encephalic Temperament 1056 

316 General Jackson 1064 

317 Daniel Defoe 1065 

318 P. T. Barnum 1068 

319 J. Minor Potts 1067 

320 Rubens, the Painter 1068 

321 Daniel Webster 1069 

322 Napoleon the First 1070 

323 Sir Walter Scott 1071 

324 Benjamin West 1072 

325 Dr. William Bvrd Powell 1073 

326 The Only Members of the 
Italian Family allowed to 
Remain 1083 

326A Eloping in 1900 1116 

327 The Apple 1126 

328 Jealousy 1135 

329 Adaptation and Inadaptation 
Illustrated • 151 

329A Plain Home Talk Babies. . . . 1157 

329B Bov or Girl, which J 1163 

.330 Horseshoe Magnet 1170 

331 A Magnetic Hammer 1171 

332 Girls on Parade 1190 



READ WHAT 

Physicians, Clergymen, Editors, 

AND 

PEOPLE GENERALLY 

HAVE SAID OF PREVIOUS EDITIONS OF DR FOOTE'S 

Plain Home Talk and Medical Common Sense 



Review of "Plain Home Talk," by the eminent English Physician, 
Essayist, and Reviewer, the late Professor Strauss. 

Near the close of September, 1887, a cablegram announced the death of Dr. G. 
L. M . Strauss, of London, England, a savant well known to scientists and people 
of literary tastes. The following review of the field of medicine is from an unpub- 
lished manuscript received a few years ago by Dr Foote, Sr. It was originally 
written as a preface to the English edition of "•Plain Home Talk, embracing 
Medical Common Sense.'" If, as was intended at that time, stereotyped plates had 
been used in London for the special English edition, the manuscript might have 
been so used ; but, for English publishers, it was decided best to continue to fur- 
nish the work in printed sheets, and the length of [Professor Strauss's article ren- 
dered it hardly suitable for the entire edition printed for use on this as on the 
other side of the Atlantic. The whole article was printed in the November, 1887, 
issue of Dr. Foote's Health Monthly, and that portion referring directly to this 
book is such a valued endorsement of it, from an unquestionably competent and 
high authority, that it is printed herewith as a suffix instead of where a preface 
belongs. 

Professor Strauss wrote : 

"7» limine, I must crave to explain briefly how I came to volunteer to write 
this Preface to the new English edition of Dr. Edward B. Foote's ' Plain Home 
Talk.' 

" Up to some thirty months or so ago Dr. Foote was personally unknown to 
me, nor had I read a line of his books, though I had, indeed, for years past, heard 
much of him and his great success in his professed Common Sense treatment of an 
almost all-embracing variety of human ailments. With a pretty long and not 
altogether uneventful professional career of my own lying behind me, I continue 
to take a warm interest in all genuine, bona fide progress of the most important of 
all sciences— Physic. 

" But I must confess that my experiences in that noble science, and with its 
professors and leaders, rather tended to predispose me to look with skeptic 
suspicion upon all claims and claimants to exceptional success in the treatment of 
diseases. 

I23I 



1 232 ADVERTISEMENTS. 

"I may conscientiously aver that I hare, from an early period of my life, 
striven hard and with honest endeavors to acquire and practise the beneficent 
healing art. I have been privileged to sit at the feet of many a reputed Gamaliel 
of the ^Esculapian science. I studied Physic under the great leaders and teachers 
of the most renowned schools and systems of my time, in Germany as well as in 
France— and in many a civil and in many a military hospital h:s the sad opportun- 
ity been most profusely offered me to see daily and hourly proof of the hopeless 
helplessness of the vaunted ars medendi, and to find, to my most bitter grief and 
deepest humiliation, that most of the fancied theoretic lore I had acquired turned 
out in the crucible of attempted practical application like unto dry bones, sapless 
chips, withered leaves, and burnt-out ash. 

* * * I was led in the end to forsake the exercise of Physic as an un- 
grateful occupation, and to take to pursuits less fraught with danger and incon- 
venience to my fellow -men. Now, with these notions of mine, it was but natural, 
I think, that, as I have stated at the outset, I should feel rather disposed to look 
with sceptic suspicion upon all claims and claimants to exceptional success in the 
treatment of diseases. I must once more observe here that at that time Dr. Foote 
was personally unknown to me, and that I had never seen a line of his medical 
writings. 

'* Now it so fell out that a young friend of mine, who had heard of Dr. Foote, 
and who had tmsuccessfully tried the ministrations of some of our most highly 
reputed doctors in a delicate case, was induced at last to consult the famous New 
York physician. I must confess it was not at my suggestion, at least, if not abso- 
lutely against my advice, that he did so. 

" He showed me the Doctor's letter in reply, and placed in my hands the reme- 
dial agents sent over to him from America. Well, the letter and the remedies — 
powerful agents compressed into the very smallest compass— staggered me consid- 
erably. Although an unsuccessful practitioner, if you will. I knew quite enough of 
my profession to see and understand that this American Doctor was a man who 
thoroughly knew what he was about, and that his practice was really based upon 
the great sound principle of Common Sense. My young friend recovered speedily 
and completely under Dr. Foote*s treatment by correspondence. It is a homely old 
saying that the proof of the pudding is in the eating. Dr. Foote's success in this 
case impressed me rather favorably: it even led me to advise some other suffering 
friends of mine to apply to the New Tork Doctor. The result was equally favor- 
ahle in every case. 

"I now for the first time procured a copy of Dr. Footers 'Plain Home Talk,' 
and read it carefully through— indeed, over and over again— and the more and the 
oftener I perused the Doctor's * Plain Home Talk ' upon Disease and its causes, 
prevention, and cure, the stronger the impression grew on my mind that here I had 
met at last with a true healer— an effective redresser of Nature's wrongs. This 
impression was confirmed and strengthened when I had the much-coveted pleas- 
ure of meeting Dr. Foote face to face, and conversing with him exhaustively upon 
the subject dearest to his heart, and engrossing all his thoughts, faculties, and 
talents: the relief of human suffering. This was some years ago, upon the occasion 
of a visit which the Doctor made to the ' old country/ 

" It was. in a great measure at least, upon my advice that Dr. Foote decided 
to publish a special edition of his ' Plain Home Talk ' for the use and guidance of 
Englishmen and Englishwomen— which I now beg leave to introduce to the fair 
notice of the British Public, fully convinced that all who will read the book with a 
candid mind and unbiased judgment, and with the honest intention of profiting to 
the fullest extent by the sage lessons and sound advice upon the most important 
questions of life and health, so intelligently and exhaustively conveyed in every 
chapter of the work, will reap a rich reward. 



ADVERTISEMENTS. J 2^ 

" ' Plain Home Talk ' may fairly be described as a veritable ' Enchiridion Medi- 
oum; ' a Compendium of sound advice upon the preservation of health and the 
proper treatment of every ill and ailment our poor human flesh is heir to, conveyed 
in plain homely language that addresses itself with straightest directness to the 
clear intelligence and understanding of all sensible men and women. 

" From the first line of the Author's own Preface to the last passus in the book, 
the work is replete with the very highest sense, Common Sense, to wit, that most 
desirable commodity which the Author truly— albeit somewhat bitterly perhaps— 
declares to be held at a discount, especially in the profession of Physic, where 
everything is proverbially ignored that has not the mustiness and dustiness of 
antiquity and incomprehensibility to recommend it to the favorable notice of the 
'learned.' The Author proceeds to characterize, rather felicitously I think, med- 
ical works in general as heterogeneous compounds of vague ideas and equally 
vague jaw-breaking words, in which the dead languages are largely employed to 
treat of living subjects. Progress, says Dr. Foote, is fully admitted to be possible 
and real in every branch of art and science and human lore— except in Medicine, 
in which it would appear the beaten old track must be stolidly pursued, although 
it has been over and over again, even superabundantly, proved and demonstrated 
to the meanest capacity, that the beaten old track is altogether the wrong road, 
and leads to perdition. Ay, he who would strike out a new path for himself runs 
the risk of being dubbed by staid medical orthodoxy an empiric— if not an impu- 
dent and ignorant quack ! However, the dread of this has clearly no terror for Dr. 
Foote, who says he is content to bear the vaporing denunciation of antiquated, 
unreasoning, and unreasonable Medical Bigotry. He cares not for personal renown 
or popularity. His chief aspiration is to strive to promote to the best of his ability 
and power the physical and moral well-being of the great human family. In his 
'Plain Home Talk ' he has endeavored to give to the world a Medical Work treat- 
ing with equal thoroughness of first causes and ultimate effects, and of all inter- 
mediate facts and circumstances bearing upon them, and written in language 
strictly mundane, and comprehensible to all alike. 

"Many of the theories which Dr. Foote advances in this work are certainly 
new, and occasionally rather startling. I must candidly admit that some of his 
notions do not run on all fours, as the common saying has it, with my own most 
cherished ideas on the same matters, though 1 do not think I am fairly open to the 
taunt of old fogyism. However, as the Doctor avouches that all his views and theo- 
ries are founded upon close observation and careful experiment, and an extensive 
successful medical practice, I say over again the proof of the pudding is in the 
eating, and objections based merely upon divergent theories should not be urged 
in opposition. 

"There is one passage in the Doctor's own Preface to his book in which I go 
along with the author to the very fullest extent. He says. ' It may sound boastful 
in a medical man to parade his great success in the practice of his art before the 
public,' but, he thinks ' it is as fair and proper in him to do so as it is in a military 
chieftain to flash his achievements on the n'eld of battle, and the long array of 
orders he has received in reward for his skill and prowess, in the eyes of an admir- 
ing and applauding people.' This remark is true to triteness. I go further— I 
maintain that as by universal assent it is so much more honorable, and certainly 
so much more beneficial to mankind, to fight fell death and combat feller disease, 
and prevent loss of limb, and restore the maimed and lamed to power and action, 
than to slay and slash— the true healer has so much more reason to exhibit his 
sigh-board, as dear Artemus used to have it ; nay, it seems to be his bounden duty to 
his suffering fellow-men to do this, that they may know where to apply for relief. 

"In conclusion I have to say a few words on a delicate subject which requires 
delicate handling. 



1234 ADVERTISEMENTS. 

"Dr. Foote in his 'Plain Home Talk 1 treats of all parts, organs, and functions 
of the human body alike, and of the derangements to which they are liable— which 
surely, to any man of plain understanding and average intellect, would seem to be 
the only Common Sense way in a professedly medical work on the preservation of 
health, and the prevention and cure of diseases. 

"There are two sets of organs and functions in the human body— the one 
devoted more especially to the preservation of the individual, the other more ex- 
clusively k> the preservation of the species. Both sets are equally important, one 
would think, or if there be a difference of degree, it surely must be held to prepon- 
derate on the side of the latter. Yet. strange to say perhaps, a somewhat tyran- 
nical custom, based upon spurious shamefacedness, or an overwrought sense of 
innate modesty, has, to a great extent at least, placed all allusions to things more 
or less immediately connected with this latter set under a kind of social taboo. 
I know this is treading on dangerous ground. I will therefore content myself here 
with referring the reader of ' Plain Home Talk ' to Dr. Foote's reasons, as stated in 
his own preface, why he has made no marked distinction in his book between the 
treatment severally of the two sets. I may perhaps be permitted, however, to 
append a single remark : 

'" Parents living in a city with dirty and dangerous back-slums in and about it, 
will, if endowed with an ordinary share of Common Sense, surely endeavor to the 
best of their ability to instruct their children, who may at some time or other have 
to pass through such objectionable places, as to their nature, and to warn them 
against the danger lurking in them. Yet will they, from mistaken delicacy and 
shame, send forth their children on their way through the infinitely more danger- 
ous back-slums of life, without instruction, without warning." 



A Physician of a Broad Education writes from Hambrook Court, 

England. 

" Dear Sir : I was in Bristol a few days ago, and when at a bookstall I saw 
your remarkable book entitled 'Plain Home Talk, 1 I began to read, but could not 
put down the book till it was read through. Although a hard student for fifty 
years. I have met with much that was new, startling, and very instructive. If 
every adult in the civilized world could read, understand, and would follow out 
your views, in a few generations there would be a world of physical, intellectual, 
and moral giants. Your work is priceless in value and calculated to regenerate 
society. 

" If there is anything you think I should like to have in tract- form, please send 
it. I have lately retired from practice, and am ready for anything In advance. 
Believe me, fraternally yours, S. Eadon. MA.. M.D., Ph.D., F.S.A., Grad. of Med. 
of Edinburgh, Glasgow, and Aberdeen.' 1 '' 



A Physician's Honest Opinion. 

Philadelphia, Pa. 
" Dear Sir : I have carefully read your book ' Plain Home Talk and Medical 
Common Sense.' and as I am myself a physician, and also have given a good deal 
of attention to social science and kindred studies, I feel competent to judge of it. 
I was strongly prejudiced against all publications-of the kind I thought this to be. 
But now I must, as an honest man, say to you that your book is an able, honest, 
and truthful presentation of facts and theories, and calculated to do much good. 
I thank you for it. You may use this letter, as I mean what I say and am not 
ashamed to say it. 

Your obedient servant, Louii Seymour." 



OPINIONS OF THE PEOPLE. 1239 

Beats them All. 

"I secured a copy of your wonderful book, 'Plain Home Talk.' Never did 
Scott, Thackeray, or Dickens claim such attention from me as did your book. 
No+hmg that has ever been written equals it. 

"Yours truly, Mrs. Jessie P. Hall, Stevenson, Ala." 



Should be Read Early in Life. 

" 'Plain Home Talk ' is very full, and I have been much interested, and only 
regret that at an earlier period of life I was not made acquainted with many of 
the physical facts which you mention. I quite think with you, that there is by far 
too much reticence displayed by parents as regards the evils to which many of the 
young are liable. I thank you for your good work. 

"Yours faithfully, John B. H. Gandy, Sheffield, England." 



Gained a Great Deal of Information. 

" I became possessed of your ' Plain Home Talk ' a little while ago, and I have 
perused its pages with much interest and benefit. I have gained therefrom a 
great deal of information upon matters of which I was almost entirely ignorant 
before I purchased your valuable work. 

" Yours very truly, A. R. Whitelock, New York City." 



Didn't Know a Doctor had so much Horse Sense. 

"Have a copy of your 'Plain Home Talk.' Didn't know a doctor had so much 
horse sense. Thought, they were full of high-flying words. Seriously, it is a great 
book, and the author is a great man. Why ! if the house caught fire, I would run 
for that book as soon as I got the insurance policy. 

" Yours truly, Watson A. Conover, Freehold, N. J." 



Brimming Over with Useful Knowledge. 

"A short time ago I received one of your books, ' Plain Home Talk,' and I am 
very much pleased with it. It is brimming over with useful knowledge, and is a 
book needed in every-day practical life. 

"Respectfully yours, Charles Wiler, Argyle, Minn." 



Would not be Without' it. 

"I have read 'Plain Home Talk and Medical Common Sense 1 and am well 
pleased with it ; would not be without it now. I only regret that I did not get 
one the first time I saw it advertised. Will show and recommend it to friends who 
take an interest in Common Sense and welfare of human mind and body. I thank 
you for the one that happened to fall into my hands. 

" Yours very truly, Geo. A. Zimmerman." 



A FEW EXPLANATORY WORDS. 

N. B. The reader will please remember that the above letters {merely samples 
of thousands received) refer to the editions of "Plain Home Talk' 1 '' published not 
long before 1900. During that year the great revision teas made, adding several 
hundred new pages, many new cuts, and eight new color plates, all of which now 
appear in the complete work, "Dr. Footers Home Cyclopedia.'''' In short the book which 
was so generally satisfactory to all sorts of people, has been made new all through % 
still more complete and even " better than the 6<?s<." 



1 240 ADVERTISEMENTS. 

THE 

MURRAY HILL SERIES! 



AN AMUSING STORY, 

IK WHICH 

Dr. Foote, Author of Plain Home Talk, etc., 

TEACHES ANATOMY, PHYSIOLOGY, and HYGIENE. 

A series for lite young, the middle-aged, the old, and everybody ! 

Five Volumes, containing in all over J ,200 pages and 400 Comic and 

Scientific Illustrations 1 1 
This series bears the name of 

"SCIENCE IN STORY; 

OR, 

Sammy Tubbs the Boy-Doctor, and Sponsie the Troublesome Monkey." . 

CHILDREN ARE CARRIED AWAY WITH IT, 

AND THE OLDER ONES ARE SPLITTING THEIR SIDES 

While reading it, and learning more than they ever before thought of respecting 
the curious mechanism of their own bodies ! ! 

Buy it for yourself ; obtain it for your children ; for, while being amused and 
entertained with the progress of Sammie and the laughable tricks of Sponsie, you 
will be acquiring the most valuable information ever presented about the con- 
struction and marvellous workings of the wonderful organs which enable you to 
live and move upon the earth as an animate and human being. 

The work is mainly sold by agents, but it may be had directly of the Publishers 
if no agents are selling it in your neighborhood. 

RETAIL- PRICES. 
Extra Cloth, inked back and sides, in set of five volumes, - $2.50 per vol. 

Tinted paper, red lined, extra English cloth, bevel boards, 
gold side and back, red edges, just the thing for Holi- 
day and Birthday Presents, in set of five volumes, - 5.00 " 

The five vols, in one, on light paper, neatly bound, ONLY, - - $2.00 

Agents Wanted for the sale of the Murray Hill Series. Teachers, and 
especially lady teachers, have unusual facilities for selling this work with benefit 
to their pupils and profit to themselves. Call on or address 

MURRAY HILL PUBLISHING COMPANY, 

m East SSth Street, tf, T, 



ADVERTISEMENTS. 1241 

"SCIENCE IN STORY;" 

Or, "Sammy Tubbs the Boy-Doctor and 
Sponsie the Troublesome IVIonWcey," 

Advertised on the preceding page, is a most attractive, original, and novel publica- 
tion from the pen of Dr. Foote. Stop a moment and give a hasty glance to the 
subjects of each volume. 

VOLUME I. 

Gives a history of Sammy's beginnings ; of Sponsie's arrival in this country, and of 
his invaluable services as a companion of the Boy-Doctor. It also imparts a clear 
knowledge of how the frame of the human body is put together and held together 
by Cartilages, Tendons, and Muscles. 

VOLUME II. 

Is humorous With April-fool jokes, fantastics, monkey-tricks, etc., and instructive 
in matter relating to the Arteries, Veins, Capillaries, Lymphatics, Lacteal Radicles, 
Villi, and all that appertains to circulation and absorption. 

VOLUME HI. 

Shows how a mischievous animal can turn a well-regulated household upside-down 
with his sly and cunning tricks. It is irresistibly funny, and at the same time it 
gives the reader a clear idea in regard to the way in which Digestion, Nutrition, 
and Respiration are performed. 

VOLUME IV. 

Gives an account of Sammy's first lecture, the masked party at the Biddlewicker's, 
the two monkey-soldiers, and the tragedy of Shin-bone Alley ; and it gives facts 
and theories of great interest respecting the Brain and Nerves. Everything in it 
is plain to those who have attentively read the preceding three volumes. Each 
volume prepares the reader for the next. 

VOLUME V. 

Treats upon the Eliminative and Reproductive Organs, and reopens the story 
which seems to close with Vol. IV. This is the most valuable and instructive of 
the whole series ; but parents who do not think it best to give their children this 
most important information, are at liberty to withhold it from them. 

EACH VOLUME 

Contains 256 pages, although the folios in some of them do not run so high in con- 
sequence of full-page pictures, which are not counted in the numbering. Each 
one is handsomely illustrated with comic pictures from the experienced hand of 
H. L. Stephens, Esq. The illustrations are copied on plates from original pen- 
and-ink designs, making the series a novelty in art as well as in matter. The 
reader is 

INSTRUCTED AS WELL AS AMUSED 

And interested in the perusal of this remarkable series. Everybody likes it, and 
everybody is buying it. 

J^lPA full contents table will be sent free to all interested parties who prefer 
to examine the summary of contents before ordering the series. Copies sent, 
postage prepaid, on receipt of the price. Neat Cloth binding, per volume, 50 cents. 
Gold embossed, red line, red edges, Si -00 per volume. (Sold only in sets.) The five 
volumes in one, on light paper, neatly bound, in Black Cloth, only $2.00. 

Agents Wanted for this series and for Dr. Foote's other publications. Cafi 
on or address MurbaY IItt.l Pubt.tshtno Company. 170 HastCCth Street, New York. 



BOOKS ON MEDICAL SOCIAL SEXUAL SUBJECTS 

DR. FOOTE 'S HOME CYCLOPEDIA; 

Dr. E. B. Foote's Complete Work, including Health and Disease, with 
Recipes, and Plain Home Talk, from new type ; with 18 color plates and 330 
other illustrations; 1248 pagres. cloth bound. Standard Edition. $3.00, Popular 
Edition, $2.00, in Leather, $4.00. Sent by mail on receipt of price. 

DR. FOOTE'S HEALTH AND DISEASE, WITH RECIPES, 

Is made up of the first 800 pages of the above work ; 14 color plates, and 
260 illustrations. In cloth, $1 .50. 

PLAIN HONE TALK, 

With Tocology for Mothers, is made up of the last 400 pages of Dr. Foote's 
Home Cyclopedia, and the following work by Dr. Westland; 4 color plates, 100 il- 
lustrations. In cloth, $1.50. 

TOCOLOGY FOR MOTHERS, 

By Dr. Westland, is a "mother's manual" about child-bearing and child- 
caring; 330 pages; illustrated. In cloth, $1.00. 

DR. FOOTE'S OFFENE VOLKS-SPRACHE 

Is the German Edition of Dr. Foote's complete book; also revised and en- 
larged in 1900; 950 pages. In cloth, $1.50. 

SCIENCE IN STORY ; or Sammy Tubbs, the Boy Doctor, and 
Sponsie, the Troublesome Honkey, for young folks. 

By Dr. E. B. Foote. Five volumes in '"red line," presentation edition, $5.00. 
Five volumes, plainer binding, $2.50 ; all in one volume, $2.00. 

SEXUAL PHYSIOLOGY FOR THE YOUNG ; 

Being fifth volume of ''Science in Story," 250 pp.; cloth bound; Ill'd; 50c. 

HAND BOOK OF HEALTH HINTS 

And Eeady Recipes; paper cover; 128 pages ; 25c. 

WONDERS, FREAKS AND DISEASES, 

A "brief" on life, health, and Autotoxaemia, illustrated, 25c. 

BORNING BETTER BABIES, 

Through regulating reproduction by controlling conception; 150 pages. 25c. 

REPLIES TO ALPHITES, 

The pro and the con of sexual continence — a debate; 128 pages. 25c. 

DIVORCE, A lecture by Dr. Foote, and extracts from noted authors. 25c. 
COMI10N SENSE CARE OF CANARIES, 

By Mrs. Farwell. Color cover. 50c. 

HOW TO flESriERIZE, By James Coates, Ph.D. Plain instruction; 50c. 
THE HUMAN FACE, How to read it, by Prof. Willis. Well illustrated. 50c. 

HOME CURE SERIES, 

Of Dime Pamphlets— on Croup; Old-eyes; Cold-feet; Rupture; Phimosis; 
Spermatorrhoea; Varicocele; Gynecology (for women); Bacteria (about vaccina- 
tion); Pleasures of Health; A Blighted Life. Eleven pamphlets, 10c. each. 

SOCIAL SCIENCE SERIES, 

Of Dime Pamphlets— Wedlock; Scientific Marriage; Heredity; A. B. C. of 
Temperaments- Powell and his Critics; Physiological Marriage; Physical Im- 
provement of Humanity; Causes of Disease, Insanity, and Premature Death ; A 
Step Backward. Any of the above books sent by mail on receipt of price. 

MURRAY HILL PUB. CO., 129 East 28th Street. 

1248 



